ATCH_14_10_May_13_PAST_PERFORMANCE_INFORMATION_SHEET.pdf

FA3002-13-R-0026

Attachment 14

ATTACHMENT 14

PAST PERFORMANCE INFORMATION SHEET

Provide the information requested in this form for each contract/program being described. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted.

A. Offeror Name (Company/Division): ___________________ CAGE Code: ___________________ DUNS Number: ___________________

(NOTE: If the company or division performing this effort is different than the offeror or the relevance of this effort to the instant acquisition is impacted by any company/corporate organizational change, note those changes. Refer to the "Organizational Structure Change History" you provided as part of your Past Performance Volume.)

B. Program Title: ___________________

C. Contract Title: ___________________

1. Contract Agency or Customer ______________________

2. Contract Number ______________________

3. Contract Type ______________________

4. Period of Performance ______________________

5. Original Contract $ Value ______________________ (Do not include unexercised options)

6. Current Contract $ Value ______________________(Do not include unexercised options)

If amounts for five (5) and six (6) above are different, provide a brief description of the reason

Brief Description of Effort as ___Prime or ___Subcontractor (Please indicate whether it was development and/or production, or other acquisition phase and highlight portions considered most relevant to current acquisition)

Completion Date

1. Original date: ________________________

2. Current Schedule: ________________________

3. Estimate at Completion: ________________________

4. How Many Times Changed: ________________________

5. Primary Causes of Change: ________________________

D. Primary Customer Points of Contact: (For Government contracts, provide current information on all three individuals, in the format shown below. For commercial contracts, provide points of contact fulfilling these same roles.)

1. Program Manager: Name _____________________ Office _____________________

FA3002-13-R-0026

Attachment 14

Address _____________________ Telephone _____________________ Email _____________________

2. Contracting Officer: Name _____________________ Office _____________________ Address _____________________ Telephone _____________________

Email _____________________

3. Administrative Contracting Officer: Name _____________________ Office _____________________ Address _____________________ Telephone _____________________ Email _____________________

E. Address any technical (or other) area about this contract/program considered unique.

F. For each of the applicable sub-factors under the Technical factor in paragraph L.1.2.A., illustrate how your experience on this program applies to that sub-factor.

G. Specify, by name, any key individual(s) who participated in this program and are proposed to support the instant acquisition. Also, indicate their contractual roles for both acquisitions.

H. Include relevant information concerning your compliance with FAR 52.219-8, "Utilization of Small Business Concerns," on the contract you are submitting.

I. Identify whether a subcontracting plan was required by the contract you are submitting. If one was required, identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.

J. Describe the nature or portion of the work on the proposed effort to be performed by the business entity being reported here. Also, estimate the percentage of the total proposed effort to be performed by this entity and whether this entity will be performing as the prime, subcontractor, or a corporate division related to the prime (define relationship).

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_215.htm#P1262_216119