FA805121R3010 Attachment 4 PPI submission form.docx
DOCX document 24 KB Posted
- Attached to
- Rapid Explosive Hazard Mitigation (REHM) Large Clearance Blade Assembly (L-CBA) Federal contract opportunity
- Solicitation number
- FA805121R3010
About this file
This document contains a past performance information submission form and details of a solicitation for the Rapid Explosive Hazard Mitigation (REHM) Large Clearance Blade Assembly (L-CBA). The submission form requests information on previous contracts and programs, including contracting agency, contract number and type, period of performance, dollar values, completion dates and changes, customer points of contact, technical areas, and small business compliance. The solicitation seeks the L-CBA and provides an SF 33 and Section J attachments for requirements. The Agency is the Department of the Air Force Materiel Command Installation and Mission Support Center Installation Contracting Agency. Responses are due as specified in the amended solicitation, with award planned for an unspecified future date. Pricing and additional terms are to be determined upon receipt and evaluation of proposals.
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Text version
FA8051-21-R-3010 ATTACHMENT #4
PAST PERFORMANCE INFORMATION
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. Limit the number of citations submitted and the length of each submission to the limitations set forth at paragraphs (II)(D)(2) and (II)(A), respectively, in Section L 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, note those changes. Refer to the "Organizational Structure Change History" you provided as part of your Past Performance Volume).
| 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__________________ | ||
| FAX Number_______________ |
2. Contracting Officer:
| Name | ____________________ | |
| Office | ____________________ | |
| Address________________________________________ | ||
| Telephone__________________ | ||
| FAX Number_______________ |
3. Administrative Contracting Officer:
Name ____________________ Office ____________________ Address________________________________________
| Telephone__________________ |
| FAX Number_______________ |
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 in Section M, illustrate how your experience on this program applies to that sub-factor.
| I. | Include relevant information concerning your compliance with FAR 52.219-8, Utilization of Small Business Concerns, on the contract you are submitting. |
| J. | 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). |
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