Atch_5_PP_Information_Sheet_(PPIS).docx

DOCX document 21 KB Posted

Attached to
Base Telecommunication Services (BTS) Federal contract opportunity
Solicitation number
FA4801-15-R-0020
Issued by
Department of the Air Force Air Combat Command

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Atch 5 PP Information Sheet (PPIS)

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Text version

FA4801-15-R-0020

ATTACHMENT 5

PAST PERFORMANCE INFORMATION SHEET for Base Telecommunications Services (BTS)

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. Provide a separate completed form for each contract/program submitted. Limit the number of past efforts submitted and the length of each submission to the limitations set forth in the Instructions to Offerors section of this solicitation.

A.Offeror Name (Company/Division):____________________
CAGE Code:____________________
DUNS Number:____________________
Performed as __Prime or __Subcontractor

B. Program Title: ____________________

C. Contract Specifics:

1. Contracting Agency or Customer _____________________________________________
2. Contract Number__________________________________________________________
3. Contract Type __________________________(i.e. Fixed Price, Cost, Time and Material, etc.)
4. Period of Performance __________________________
5. Place of Perfornace _____________________________
6. Original Contract $ Value_________________ (Do not include unexercised options)
7. Current Contract $ Value_________________ (Do not include unexercised options)
8. If Amounts for 5 and 6 above are different, provide a brief description of the reason ____________________________________________________________________________________________________________________________________________________________________________________________________

D. __Prime or __Subcontractor. Describe the effort your company performed. Provide rationale supporting recency and relevance (as defined in the 52.212-1, Instructions to Offerors and 52.212-2, Evaluations (including Addendums) of the solicitation). Provide frank, concise comments regarding your performance on this contract to substantiate a rating of acceptable as defined in the Instruction to Offeror of the solicitation. Use additional space as required.

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/orName____________________
Site ManagerOffice____________________
Address____________________
____________________
Telephone__________________
FAX Number_______________
2. Contracting Officer:Name____________________
Office____________________
Address____________________
____________________
Telephone__________________
FAX Number_______________
3. AdministrativeName____________________
Contracting Officer:Office ____________________
Address____________________
____________________
Telephone__________________
FAX Number_______________

4 April 2016 Attachment 5 Page 1 of 2

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