Attachment_4_Past_Performance_Information_Form.docx
DOCX document 46 KB Posted
- Attached to
- Line Operations Safety Audit (LOSA) Federal contract opportunity
- Solicitation number
- FA7014-19-R-LOSA
About this file
Past Performance Information Form
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment_1_-_PWS_Final_rev1.docx | DOCX document | |
| LOSA_QandA_8-9-19.xlsx | XLSX spreadsheet | |
| Attachment_3_Past_Performance_Questionnaire.docx | DOCX document | |
| Attachment_2_Solicitation_Bid_Schedule.xlsx | XLSX spreadsheet | |
| LOSA_Combo_Final.docx | DOCX document | |
| Attachment_1_-_PWS_Final.docx | DOCX document |
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Text version
PAST PERFORMANCE INFORMATION FORM
Line Operations Safety Audit (LOSA) - FA7014-19-R-LOSA
PAST PERFORMANCE REFERENCES THAT ADDRESSES THE TASK AND FUNCTIONAL AREAS OF THE PWS
| A. |
| OFFEROR IDENTIFICATION |
1. Company/Division Name:
2. CAGE Code:
3. 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).
| B. |
| PROGRAM TITLE |
| C. |
| CONTRACT SPECIFICS |
1. Contracting Agency/Customer:
2. Contract Number:
3. Contract Type:
4. Period of Performance:
5. Total Number of FTEs
6. Original Contract $ Value:
(Do not include unexercised options)
7. Current Contract $ Value:
(Do not include unexercised options)
8. If Amounts for 6 and 7 above are different, provide a brief description of the reason:
| D. |
| BRIEF DESCRIPTION OF EFFORT AS PRIME SUBCONTRACTOR (Mark One) |
(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/Site Manager:
a) Name
b) Office
c) Address
d) Telephone
e) FAX Number
f) E-Mail Address
2. Contracting Officer:
a) Name
b) Office
c) Address
d) Telephone
e) FAX Number
f) E-Mail Address
3. Administrative Contracting Officer:
a) Name
b) Office
c) Address
d) Telephone
e) FAX Number
f) E-Mail Address
| G. |
| ADDRESS ANY TECHNICAL (OR OTHER) AREA ABOUT THIS CONTRACT/ PROGRAM CONSIDERED UNIQUE |
| H. |
| ILLUSTRATE HOW YOUR EXPERIENCE/KNOWLEDGE ON THIS PROGRAM APPLIES TO THE FUNCTIONAL AREAS LISTED BELOW: |
| I. |
| KEY INDIVIDUALS |
(Specify any key individual(s) who participated in this program and are proposed to support the instant acquisition, to include their contractual roles for both acquisitions.)
| Name |
| Referenced Program |
Contractual Role Proposed Contractual Role
| J. |
| COMPLIANCE WITH FAR 52.219-8, UTILIZATION OF SMALL BUSINESS CONCERNS (if applicable) |
(Include relevant information concerning your compliance on the submitted contract.)
| K. |
| SUBCONTRACTING PLAN PLANNED/ACHIEVED GOALS (if applicable) |
(Identify whether a subcontracting plan was required by the contract you are submitting. If so, identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.)
Subcontracting Plan Required: YES NO (Mark One)
| Category |
| Planned |
| Achieved |
a) Small Business
b) Small Disadvantaged Business
c) Service Disabled Veteran Owned Business
d) Veteran-Owned Small Business
e) Women-Owned Small Business
f) HUBZone Small Business
Explanation if goals were not met:
| L. |
| NATURE OR PORTION OF THE WORK ON THE PROPOSED EFFORT TO BE PERFORMED BY THE BUSINESS ENTITY LISTED IN SECTION K (if applicable) |
(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)).
| M. |
| CONTINUATION FOR ITEMS A THROUGH L |
(The offeror may provide additional information or explanation for Items A through L, above, if necessary. The offeror must clearly identify the applicable Item(s) by Letter/Number for which the additional information or explanation applies.)
Past Performance Information Form Attachment 08 Page 1 of 6
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