Att 04 - PPI.pdf

Attachment 04:

Form L-1 Past Performance Information Form

13 June 2011

RFP FA9301-11-R-0016

Attachment 04

Form L-1, Past Performance Information Form

Provide the information requested in this form for each contract/program being described. Provide 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 and the length of each submission to the limitations set forth at paragraphs 2.1.2 of Addendum to 52.212-1 INSTRUCTIONS TO OFFERORS –

COMMERCIAL ITEMS.

A. Offeror Information

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 (include email address and phone number): :

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

Prime:

Subcontractor:

RFP FA9301-11-R-0016

E. Completion Dates

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 Contracting Officer

Name:

Office:

Address:

Telephone:

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

H. For each of the applicable sub-factors under the Technical Capability factor in Addendum 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS, 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. 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):