FA3047-12-R-0026 Attachment 5 Past Performance Information Sheet.docx

FA3047-12-R-0026 - ATTACHMENT 5

Addendum to FAR 52.212-1

PAST PERFORMANCE INFORMATION

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. Limit the number of past efforts submitted and the length of each submission to the limitations set forth at paragraph 2.C.b. of the Addendum to FAR 52.212-1 of this solicitation.

(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).

B. Program Title:

C. Contract Specifics:

D. 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)

E. Completion Date:

F. 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).

1. Program Manager and/or Name Site Manager:

Office:

Address:

2. Contracting Officer Name:

3. Administrative Contracting Officer Name:

Office Address

Telephone FAX Number

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

H. For each of the applicable subfactors under the Mission Capability factor in the Addendum to FAR 52.212-2, illustrate how your experience on this program applies to that subfactor.

I. 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.

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

K. State Licensing Agency Only - Subcontracting Plan. Identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.

L. 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).