Past Performance Info Sheet.pdf

PAST PERFORMANCE INFORMATION SHEET

Provide the information requested in this form for each contract/program being described. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted.

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 provided as part of your Past Performance Volume).

B. Program Title: ____________________

C. Contract Specifics:

1. Contracting Agency or Customer _____________________________________________

2. Contract Number __________________________________________________________

3. Contract Type __________________________

4. Period of Performance __________________________

5. Original Contract $ Value _________________ (Do not include unexercised options)

6. Current Contract $ Value _________________ (Do not include unexercised options)

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

D. Brief Description of Effort as __Prime or __Subcontractor

(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 and/or Name ____________________

Site Manager Office ____________________

Address ____________________

Telephone __________________

FAX Number _______________

2. Contracting Officer: Name ____________________

Office ____________________

Address ____________________

Telephone__________________

FAX Number_______________

3. Administrative Name ____________________

Contracting Officer: Name ____________________

Office ____________________

Address ____________________

Telephone__________________

FAX Number_______________

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

H. For each of the applicable subfactors under the Mission Capability factor in ADDENDUM to 52.212-2, illustrate how your experience on this program applies to that 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.

K. Identify whether a subcontracting plan was required by the contract you are submitting. If one was required, identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.