Section_J _Attachment_11_-_Past_Performance_Information_8_May_13.docx

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Systems Engineering, Management, and Sustainment (SEMS) III
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FA4600-12-R-0013
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Section J Attachment 11 - Past Performance Information (incorporated in Amendment 0002)

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FA4600-12-R-0013-0002

SECTION J

ATTACHMENT 11: PAST PERFORMANCE INFORMATION

Provide the information requested in this form for each contract/task order/program (citation) being described. Provide frank, concise comments regarding your performance on the contracts/ task order you identify. Provide a separate completed form for each contract/task order/program submitted. Limit the number of citations submitted and the length of each submission to the limitations set forth at paragraph 4.5 of Section L 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/Task Order Specifics:

1. Contracting Agency or Customer _____________________________________________
2. Contract/Task Order Number__________________________________________________________.
3. Contract type: Cost-Reimbursement: CPIF---- CPAF---- Other (explain)____________________
Fixed Price: FFP----FPIF---- Other (explain) _______________________________________
4. Period of Performance __________________________
5. Original Contract/Task Order $ Value _________________
6. Current Contract/Task Order $ Value _________________
7. If Amounts for 5 and 6 above are different, provide a brief description of the reason ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. Brief Description of Effort as __Prime __Subcontractor or __Joint Venture (Please indicate whether it was development and/or production, or other acquisition phase (or Service) and highlight portions considered most relevant to current acquisition – If Subcontractor or Joint Venture – indicate actual dollar value of work completed)

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/task order/program considered unique.

H. For each of the subfactors listed under the Past Performance Relevancy Criteria in Section M, illustrate how your experience on this program applies to that sub-factor.

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

J. Identify whether a subcontracting plan in accordance with FAR 52.219-9, Small Business Subcontracting Plan, was required by the contract/task order you are submitting. If one was required, identify, in percentage terms, the planned versus achieved goals during contract/task order performance. If goals were not met, please explain.

K. 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).

L. Identify any Earned Value Management (EVM) or similar metrics required to track contract/task order performance. If such metrics were required for this contract, provide the summary level data.

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