ATTACHMENT 22 20 Oct 10 Section L Attachment 1 - PAST PER INFO SHEET.pdf

FA8617-11-R-6208

Section J, Attachment 22

20 Oct 10

SECTION L - ATTACHMENT 1: PAST PERFORMANCE INFORMATION SHEET

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 5.2 and 2.2, respectively, of Section L-Volume III 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. Initial Contract Cost/Price __________________________

6. Current/final Contract Cost/Price __________________________

7. Annual Contract $ Value __________________________

8. 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 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: Name ____________________ Office ____________________ Address ____________________ Telephone ____________________

2. Contracting Officer: Name ____________________ Office ____________________ Address ____________________ Telephone ____________________

3. Administrative Name ____________________ Contracting Officer Office ____________________ Address ____________________ Telephone ____________________

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

H. For each of the applicable subfactors under the technical factor in Section M, illustrate how your experience on this program applies to that subfactor.

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

J. Include relevant information concerning your compliance with subcontracting plan goals for small disadvantaged business (SDB) concerns, monetary targets for SDB participation, and notifications submitted under FAR 52.219-25, Small Disadvantaged Business Participation Program—Disadvantaged Status and Reporting.

K. Include relevant information concerning your compliance with FAR 52.219-8, Utilization of Small Business Concerns, on the contract you are submitting.

L. Identify whether a subcontracting plan in accordance with FAR 52.219-9, Small Business Subcontracting Plan, was required by the contract you are submitting. If one was required, identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.

M. 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 https://www.afmc-mil.wpafb.af.mil/HQ-AFMC/PK/afmcfars/far/FAR52.215.doc#b5221925� https://www.afmc-mil.wpafb.af.mil/HQ-AFMC/PK/afmcfars/far/FAR52.215.doc#b522198� https://www.afmc-mil.wpafb.af.mil/HQ-AFMC/PK/afmcfars/far/FAR52.215.doc#b522199� 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).

N. Identify any Earned Value Management (EVM) or similar metrics required to track contract performance. If such metrics were required for this contract, provide the summary level data.

SECTION L - ATTACHMENT 1: PAST PERFORMANCE INFORMATION SHEET