Atch 16_Performance Info Form.pdf

Attachment 16

PERFORMANCE INFORMATION FORM

I. Offeror Name (Company/Division)

CAGE CODE: DUNS NUMBER:

(If other than the prime offeror, identify prime offeror)

II. PROGRAM TITLE:

III. CONTRACT SPECIFICS:

A. Contracting Agency or Customer:

B. Contract Number:

C. Contract Type:

D. Period of Performance (include exercised options):

E. Contract Dollar Value:

F. Has the contract been entered into the Construction Contractor Appraisal Support System

(CCASS)? YES NO

IV. Brief Description of Contract as Prime Subcontractor

Indicate the type of services provided and highlight portions considered most relevant to this solicitation requirement. Include information required by (f)(4)(i)(ii)(iii) above.

V. Explain corrective actions taken in the past, if any, for substandard performance and any current performance problems such as cost overruns, extended performance periods, numerous warranty calls, etc.)

VI. Primary Customer Points of Contact: For Government contracts, provide the following information for the Program Manager and Contracting Officer. For commercial contracts, provide equivalent information. Ensure the individuals are currently available to provide past performance information on attached questionnaire.

(1) Name:

(2) Office:

(3) FAX Number:

(4) Email Address:

(5) Telephone Number: