Atch_6_Past_Performance_Information_Sheet_(PPIS) _dtd_15_Sep_2016.docx
DOCX document 21 KB Posted
- Attached to
- Advanced Life Support (ALS) (Ambulance) Federal contract opportunity
- Solicitation number
- FA4801-16-R-0007
About this file
Atch 6 Past Performance Information Sheet (PPIS) dtd 15 Sep 2016
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Text version
Sol # FA4801-16-R-0007
ATTACHMENT 6
PAST PERFORMANCE INFORMATION SHEET for
ADVANCE LIFE SUPPORT (ALS)
(Ambulance) SERVICES
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 Performace _____________________________ | |
| 6. Original Contract $ Value | _________________ (Do not include unexercised options) |
| 7. Current Contract $ Value | _________________ (Do not include unexercised options) |
| 8. If Amounts for 6 and 7 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/or | Name | ____________________ |
| Site Manager | Office | ____________________ |
| Address | ____________________ | |
| ____________________ | ||
| Telephone__________________ | ||
| FAX Number_______________ |
| 2. Contracting Officer: | Name | ____________________ |
| Office | ____________________ | |
| Address | ____________________ | |
| ____________________ | ||
| Telephone__________________ | ||
| FAX Number_______________ |
| 3. Administrative | Name | ____________________ |
| Contracting Officer: | Office ____________________ | |
| Address | ____________________ | |
| ____________________ | ||
| Telephone__________________ | ||
| FAX Number_______________ |
15 Sep 2016 Attachment 6 Page 1 of 2
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