FA4620-12-R-B001 Atch 4 Past Performance Information.pdf

SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104

FA4620-12-R-B001

Attachment 4 5 April 2012

SECTION L

PAST PERFORMANCE INFORMATION

Limitations: 5 Contracts

Provide the information requested in this form for each contract/program being described.

Provide frank, concise comments regarding your performance on the contracts you identify.

Limit the number of past efforts submitted and the length of each submission to the limitations set forth at Section L, Paragraph 2.2.2 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:

Contracting Agency or Customer:

Contract Number: Contract Type:

Contract Type: Period of Performance:

Original Contract $ Value: Current Contract $ Value:

(Do not include unexercised options) If Original $ Value and Current $ Value 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 and highlight portions considered most relevant to current acquisition)

E. Completion Date:

Original Date: Current Schedule:

Estimate at Completion:

How Many Times Changed:

Primary Causes of Change:

FA4620-12-R-B001

Attachment 4 5 April 2012

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 Number: Fax Number:

2. Contracting Officer

Name:

Office/Address:

Telephone Number: Fax Number:

3. Administrative/Contracting Officer

Name:

Office/Address:

Telephone Number: Fax Number:

G. Address any design efforts associated with this contract/program. Indicate design contractor’s cost, scope, and any challenges on schedule concerns regarding the design.

H. 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 to include the design contractor’s contact information (address and phone number).

I. Describe the nature or portion of the work on the effort performed by the business entity being reported here. Also, estimate the percentage of the total proposed effort 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).