11-PPI AMD 0001.pdf

FA440723R0002

Attachment 11

PAST PERFORMANCE INFORMATION

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-2.2.2.1 of Section L – Instructions to Offerors of this solicitation.

A. Offeror Name (Company/Division): ___________________________________________________

Unique Entity Identifier (UEI):____________________

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__________________

Email_______________

2. Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

Email_______________

3. Administrative Contracting Officer:

Name ____________________

Office ____________________

Address________________________________________

Telephone__________________

Email_______________

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

H. For each of the applicable sub-factors under the Performance factor in Section M, illustrate how your experience on this program applies to that sub-factor.

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.

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).