past_perf_info_ktr1.pdf

FA3020-14-R-0011

Atch 4

PAST PERFORMANCE INFORMATION

Revised 17 April 2014

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): ____________________ DUNS Number:____________________

B. Program Title:____________________________________

C. Contract Specifics:

1. Contracting Agency or Customer _____________________________________________

2. Contract Number__________________________________________________________

3. Contract Type (i.e., FFP) __________________________

4. Period of Performance __________________________

5. Original Contract $ Value _________________

D. Brief Description of Effort as __Prime or __Subcontractor

E. Primary Customer Points of Contact: (For Government contracts provide current information on all three individuals. For commercial contracts, provide points of contact fulfilling these same roles).

Contracting Officer/Contract Specialist:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

Email _______________________