Attachment_3_Volume_IV_Past_Performance_Reference_Form.doc

Past Performance Information Form

Solicitation FA7014-16-R-5007

PAST PERFORMANCE INFORMATION FORM

Note: For Past Performance Volume II

NTE 3 Past Performance References Provide the information requested in this form for each contract/program (citation) being described. Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Submit no more than three completed forms in total.

A.

Offeror Name (Company/Division):

CAGE Code:____________________

DUNS Number:____________________ 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 (or Service) 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 Site Manager:

Name

Office

Address________________________________________

Telephone__________________

Email Address_______________

2. Contracting Officer:

Name

Office

Address________________________________________

Telephone__________________

Email Address _______________

3. Administrative Contracting Officer:

Name Office ____________________ Address________________________________________

Telephone__________________

Email Address _______________

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

H. For each of the applicable sub-factors under the Technical factor, illustrate how your experience on this program applies to that sub-factor.

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).

J. CONTINUATION: Provide any additional Information related to your past performance on the contract/program submitted that you consider to be appropriate for evaluation, or that provides additional information applicable to items A through I, above: