Attachment 16 Draft Standard HTRO Past Performance Questionnaire.doc

Source Selection Information - See FAR 2.101 & 3.104

HTRO Past Performance Questionnaire Instruction:

The Offeror, either as a Prime or Subcontractor on the work sample submitted, is to fill in Paragraph 1 of this Past Performance Questionnaire, then route the form to a US Government (USG) Point of Contact who can substantiate the claimed Paragraph 1 Past Performance. The description of the effort SHALL be a ‘Copy and Paste’ of the EXACT wording from the specific FOPR qualification category description in the Evaluation Criteria. The Offeror shall provide this questionnaire to an appropriate Government POC who is familiar with the effort claimed. The Government POC will fill out and sign this form, and provide the completed form to the Offeror to be included in the Offeror’s proposal. The Offeror shall submit the completed form IAW the FOPR instructions. This form can be submitted from multiple sources, as needed.

Offeror Information:

Name:

Point Of Contact (POC): ________________________________________________________________ Phone/ Email:_________________________________________________________________________

1. The US Air Force is conducting a Fair Opportunity competition for A&AS efforts. The Offeror named above claims during the dates from _________ to _________ to have accomplished the following on Contract/Task Order #______________:

2. The US Air Force Contracting Officer for this A&AS Fair Opportunity Selection requests that a USG representative with cognizance on the above mentioned Contract/Task Order verify that the effort claimed in Paragraph 1 is accurate to the best of your knowledge.

Is the effort mentioned in Paragraph 1 accurate? Yes_________ No_________ US Government/Customer POC:

Name: _________________

Duty title: ______________

Phone: _________________

Email: _________________

Branch: ________________ Signature:_____________________________ Date:___________________

FA2486-20-F-1001

Source Selection Information - See FAR 2.101 & 3.104 Source Selection Information - See FAR 2.101 & 3.104