10-PPI_v2.pdf

FA440719RA002

Attachment 09

PAST PERFORMANCE INFORMATION

Revised 14 April 2011

Provide the information requested in this form for each contract/program (citation) 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 citations submitted and the length of each submission to the limitations set forth at paragraph L-2.2.3.1 of Section L – Instructions to Offerors of this solicitation.

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 Specifics:

1. Contracting 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)

7. If Amounts for 5 and 6 above are different, provide a brief description of the reason

D. Brief Description of Effort as __ Prime or __ Subcontractor

(Please indicate whether it was development and/or production, or other acquisition phase (or Service) and highlight portions considered most relevant to current acquisition)

E. Completion Date:

1. Original date: ____________________

2. Current Schedule: ____________________

3. Estimate at Completion: ____________________

4. How Many Times Changed: ____________________

5. Primary Causes of Change: _______________________________________________________

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 Site Manager:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

FAX Number_______________

2. Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

FAX Number_______________

3. Administrative Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

FAX Number_______________

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

H. Specify, by name, any key individual(s) who participated in the previous project and are proposed to support the new acquisition. Also, indicate their contractual roles for both acquisitions.

I. Describe the nature or portion of the work on the past effort performed by the business entity being reported here. Also, estimate the total percentage on the new proposed effort to be self-performed by this entity as the prime.