Attachment_III,_PPQ.pdf

FA440719QA024

Attachment III

PAST PERFORMANCE INFORMATION

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)