Atch 41- Past Peformance Information Sheet.pdf

PAST PERFORMANCE INFORMATION SHEET

FA4861-19-R-A001

Nellis/Creech MACC

Provide the information requested in this form for each contract/program being described.

Comments shall be frank and concise 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 at paragraphs and respectively, of 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, note those changes. Refer to the “Organizational Structure Change History” you provide as part of your Past Performance Volume.)

B. Program Title:

C. Contract Specifics:

1. Contracting Agency or Customer:

2. Contract Number (include order number if applicable:

3. Contract Type (FFP, Cost, etc):

4. Period of Performance:

5. Original Contract $ Value:

6. Current Contract $ Value:

7. If Amounts for 5 and 6 above are different, provide a brief description of the reason:

D. Brief Description of Contract.

Effort was performed as Prime or Subcontractor (Provide brief description of effort performed under this contract and highlight portions considered most relevant to current acquisition.)

E. Are there Contractor Performance Assessment Reports (CPARS) available for this contract? Yes No

FA4861-19-R-A001

Nellis/Creech MACC

F. Completion Date

1. Original Date:

2. Current Schedule:

3. Estimate at Completion:

4. How many times changed:

5. Reason for change:

G. Primary Customer Points of Contact: Primary Customer Points of Contact (POC):

[Identified POCs should be individuals most knowledgeable about your performance, i.e., contracting officers, technical representatives, program manager, or the commercial equivalent of these individuals. Please identify a minimum of 2 POCs for each contract. IAW Section L of the solicitation, questionnaires should be sent to these same individual(s).]

1. Name:

Office:

Address:

Telephone:

Fax Number:

E-mail:

2. Name:

Office:

Address:

Telephone:

Fax Number:

E-mail:

3. Name:

Office:

Address:

Telephone:

Fax Number:

E-mail:

FA4861-19-R-A001

Nellis/Creech MACC

H. Address any technical (or other) area about this contract/program considered unique.

I. 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).