Atch_18_Past_Performance_Information.pdf

FA440718R0004

Attachment 17

PAST PERFORMANCE INFORMATION

Revised 29 May 2018

Provide the information requested in this form for each contract described. Provide concise comments regarding performance on the contracts you identify. Provide a separate completed form for each contract submitted. Limit the number of citations submitted and the length of each submission to the limitations set forth at paragraph L-2.2.2.1 of Section L – Instructions to Offerors of this solicitation.

A. Contractor Information

Firm Name: ___________________________________________________________________________

Address:______________________________________________________________________________

CAGE Code: ______________________________ DUNs Number: ______________________________

Phone Number: ________________________________________________________________________

Email Address:_________________________________________________________________________

Point of Contact: __________________________Contact Phone Number__________________________

B. Contract Information

Contract Number: ______________________________________________________________________

Delivery/Task Order Number (if applicable): _________________________________________________

Contract Type: Firm Fixed Price/Cost Reimbursement/Other (Please specify):_______________________

Contract Title: _________________________________________________________________________

Contract Performance Location: __________________________________________________________

Work Performed as: _____Prime Contractor _____Sub Contractor _____Joint Venture Other (Explain)_________________________________________________________________________

Percent of Project Work performed: ________________________________________________________

If subcontractor, who was the prime (Name/Phone #): __________________________________________

Award Date (mm/dd/yy): ________________________________________________________________

Original Contract Completion Date (mm/dd/yy):______________________________________________

Actual Completion Date (mm/dd/yy): _______________________________________________________

Explain Differences/Reasons for Changes in Schedule:

Original Contract Price (Award Amount): ___________________________________________________

Final Contract Price (to include all modifications, if applicable): _______________________________

How Many Times Changed: ____________________

Explain Primary Causes of Change:

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

Program Manager and/or Site Manager:

Name ____________________

Office ____________________

Email Address______________

Telephone__________________

Contracting Officer:

Name ____________________

Office ____________________

Email Address______________

Telephone__________________

Other Reference/Title:

Name ____________________

Office ____________________

Email Address______________

Telephone__________________

D. Brief Description of Effort

E. Technical or Other Issues Unique to Effort (if any)