Attch_12a_PPI_Form.pdf

ADDENDUM TO 52.212-1 INSTRUCTIONS TO OFFERORS

Attachment 12a

PAST PERFORMANCE INFORMATION (PPI)

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. Limit the number of past efforts submitted and the length of each submission to the limitations set forth at paragraph 7.2

A. General Information.

Offeror Name (Company/Division)*

CAGE Code DUNS Number Program Title Contracting Agency or Customer

Contract Type (FFP, CR, ID/IQ, LH, etc.) Period of Performance (PoP)

Contract Number/Task Order Number

Total Contract $ Value (with all options)

*NOTE: If the company or division referenced above is different than the offeror, note those changes (see 7.8).

B. Brief Description of Effort as (check) Prime Subcontractor Teaming Partner Joint Venture Other (Specify) __________________________________________

Provide a brief description of service provided under this contract. Provide details on how reference is relevant in demonstrating the ability to perform the MPF PWS requirements and explain how/why the referenced contracts are relevant IAW the relevancy definitions at Attachment 13 Addendum to 52.212-2 Evaluation – Commercial Items.

As applicable, address how the proposed effort relates to factors shown in Paragraph 3.2.4.1., Items 1 and 2.

C. 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.

Program Manager/Site Manager/Quality Assurance Evaluator (specify which):

Name Office

Telephone Address

FAX E-mail

Procuring Contracting Officer:

Name Office

Telephone Address

FAX E-mail

Administrative Contracting Officer:

Name Office

Telephone Address

FAX E-mail

Other (Please specify):

Name Office

Telephone Address

FAX E-mail

D. Describe the nature and portion (percentage) of the work to be performed on the Multiple Personnel Functions (MPF) contract by the company referenced on this PPI and whether performing as the Prime, subcontractor, or a corporate division related to the prime (define relationship).