Attachment_4_-_Past_Performance_Information_Reference.pdf

FA4855-17-R-0008

Attachment 4 22 May 2017

Past Performance Information Reference Provide the information requested in this form for each one of the present or past contracts identified as recent and relevant for this solicitation. Provide a separate completed form for each contract identified. Attach one separate sheet if additional space is needed.

A. Current Offeror (Company/Division):

Cage Code:

DUNS Number:

Additional Information: (If Present/Past Performance is for major subcontractor, please provide Company Name of subcontractor and annotate in this block “Subcontractor”. If the company or division performing this present or past effort is different from the current Offeror, note this fact in the space provided. Refer to the “Organizational Structure Change History” provided as part of the Past Performance Volume.)

B. Program Title:

C. Contract Specifics

1. Customer Name:

2. Customer Address and Phone No.

3. Contract Number and all applicable Order Numbers (i.e. Task Order, Delivery, Order, etc.):

4. Type of Contract

5. Period of Performance

6. Initial Contract Price/Cost $

7. Final Amount Invoice/Amount Invoice to Date: $

8. Reason for Change(s) in Value:

9. Original Completion Date:

10. Current Scheduled Completion Date:

11. Number and Reason for Change(s) in Schedule:

D. Description of Effort as Prime or Subcontractor

E. Describe how the work under this contract relates to this requirement. Please reference PWS paragraphs and relevancy definition used in FAR 52.212-2 addendum when appropriate.

FA4855-17-R-0008

Attachment 4 22 May 2017

F. Self-assessment of past performance record. Provide information of any problems encountered and your corrective actions.

G. Current Status of Contract

H. Primary customer points of contact.

POINTS OF CONTACT

Program Manager Contracting Officer Admin Contracting Officer

Name:

Office:

Address:

Phone:

E-Mail:

Other (specify)::

Name:

Office:

Address:

Phone:

E-Mail:

Past Performance Information Reference