Attachment_6_-_Past_Performance_Questionnaire.doc

PERFORMANCE INFORMATION FORM

I.

Offeror Name (Company/Division)

CAGE CODE:

DUNS NUMBER:

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)? FORMCHECKBOX

YES FORMCHECKBOX

NO

IV.

Brief Description of Contract as FORMCHECKBOX Prime FORMCHECKBOX 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.

On a separate sheet, 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/or Contracting Officer. For commercial contracts, provide equivalent information.

(1) Name:

(2) Office:

(3) FAX Number:

(4) Email Address:

(5) Telephone Number: