FA4819-09-R-0038 Attachment 5 L-1 Past Performance Information.docx

FA4819-09-R-0038 AIRFIELD PAVING TYNDALL AFB - Attachment 5 L -1 Past Performance Information Sheet

Provide the information requested in this form for each contract being described. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract submitted. Limit the number of past efforts submitted to the limitations set forth in 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, explain here:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ B. Program Title: ______________________________________________________________________ C. Contract Specifics

1. Contracting Agency or Customer: ______________________________________________

2. Contract Number/Task Order: _________________________________________________

3. Contract Type: _____________________________________________________________

4. Period of Performance: ______________________________________________________

5. Bonding company name, point of contact, and telephone number: ______________________________________________________________________________

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: ______________________________________________________________________________

9. Award Fee Pool Amount (if applicable):_______________________________________________ D. Brief Description of Effort as _______ Prime or ____ Subcontractor (check one) (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

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 Name: _________________________________________

2. Office: ________________________________________________________

3. Address: _______________________________________________________

4. Phone: __________________________________________________________

5. Email: __________________________________________________________

6. Contracting Officer Name: _________________________________________

7. Office: __________________________________________________________

8. Address: _________________________________________________________

9. Phone: ___________________________________________________________

10. Email: __________________________________________________________

11. Administrative Contracting Officer Name: _____________________________

12. Office: __________________________________________________________

13. Address: _________________________________________________________

14. Phone: ___________________________________________________________

15. Email: __________________________________________________________ G. Address any technical (or other) area about this contract/program considered unique: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ H. For each of the applicable subfactors under the Technical Acceptability factor in Section M, illustrate how your experience on this program applies to each subfactor. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 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. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ J. 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). ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SOURCE SELECTION SENSITIVE – SEE FAR 2.101 AND 3.104