ATTACH~1.DOC

FA568219RA001

Attachment 4

PAST PERFORMANCE INFORMATION (PPI) SAMPLE

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 to the limitations set forth in Section L, Instructions to Offerors, paragraph L.5.2.3. 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, please note those changes accordingly.)

B. PROGRAM TITLE:

C. CONTRACT SPECIFICS

a) Contracting Agency/Customer

b) Contract Number or contract number and Task Order (TO) Number if applicable

c) Contract Type

d) Total contract Dollar/EURO value and total TO Dollar/EURO value if applicable

e) Date of Award

f) Period of Performance

g) Narratives addressing how performance of the subject contract is relevant to the requirements of this solicitation

h) Description of the role of the offeror

i) Contracting Officer’s Name or Commercial Customer POC, Telephone Number and e-mail Address D. BRIEF DESCRIPTION OF EFFORTS AS CONTRACTOR: (Please highlight portions considered most relevant to the current acquisition. Discuss efforts/management actions accomplished to successfully overcome and resolve any problems encountered.)

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 (POCs): (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. Questionnaires shall be sent to these same individual(s) IAW Section L, Instructions to Offerors, Paragraph L.5.2.3, Past Performance Information, of this solicitation.)

Office:

Telephone:

E-mail:

Office:

Telephone:

E-mail:

G. Specify, by name, any key individual(s) who participated in this contract and are proposed to support the instant acquisition. Also, indicate their contractual roles for both acquisitions.

H. Describe the nature of the work on the proposed effort to be performed by the business entity being reported here.

I. Identify and explain which aspects of the proposed effort and how they relate to the requirement described in this solicitation. Please see Section L.5.2.3.1.

For Official Use Only