Attachment L5 - Past Performance Fact Sheet.docx

Controlled Unclassified Information When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Section L Attachment: Past Performance Fact Sheet

TO BE COMPLETED BY OFFEROR

Section 1: Contract Identification

A. Company/Division name:

B. Product/Service:

C. Contracting Agency/Customer:

D. Contract Number:

E. Contract Dollar Value:

F. Period of Performance:

G. Verified, up-to-date name, mailing and e-mail addresses, and telephone number of the contracting officer (Point-of-Contact)

H. Comments regarding compliance with contract terms and conditions

I. Comments regarding any known performance deemed unacceptable to the customer, or not in accordance with the contract terms and conditions.

J. Include rationale supporting your assertion of relevance and identify aspects (scope, magnitude of effort, and complexity) of the contracts deemed relevant and how they relate to the proposed effort.

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Signature of Offeror

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