FA9301-15-R-0005 _Attachment_9 _L-3_PPIF3.pdf

PAST PERFORMANCE INFORMATION FORM

Provide all information requested on this form for each contract/task order being submitted.

Provide brief and concise descriptions of your performance on the contracts/task orders you identify and use a separate form for each contract/task order. Limit the number of past efforts submitted to the limitations set forth in Section L001 of the 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, explain here:

B. Program Title:_______________________________________________________________

C. Contract Specifics:

1. Contracting Agency or Customer:_______________________________________________

2. Contract Number/Task Order/Job Order:__________________________________________

3. Contract Type (Check all that apply: ☐ Fixed Price ☐ IDIQ ☐ Cost ☐ Other: (specify)______________

4. Role: ☐ Prime ☐ Sub-contractor ☐ Other: (Specify)________________________

5. Job Disciplines:

☐Asbestos Abatement ☐Demolition ☐Lead Paint Remediation ☐ Other: _________________________________________________________________

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Contract Environment:

☐ Military Installation in California ___________________________________________

☐ Federal, State, or Local Government Agency __________________________________

☐ Other__________________________________________________________________

6. Period of Performance: From _______________________ To ______________________

7. Contract/Order/Project Amount: _______________________________________________

8. If the above is an Indefinite Delivery type contract, please list the highest aggregate amount of all Task Orders performed concurrently under this contract:

9. Original Contract $ Value: $_____________________ (Do not include unexercised options)

10. Current Contract $ Value: $_____________________ (Do not include unexercised options)

11. If the amounts for 10 and 11 above are different, provide a brief description of the reason:

D. Brief Description of Effort as a Prime_____ Subcontractor ____ or Other _____

E. Completion Date

1. Original Date: ________________________________________________________________

2. Current Schedule: _____________________________________________________________

3. Estimate at Completion: ________________________________________________________

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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: _____________________________________________________

2. Office: _____________________________________________________________________

3. Address: ____________________________________________________________________

4. Phone: _____________________________________________________________________

5. Email: ______________________________________________________________________

6. Contracting Officer Name: ____________________________________________________

7. Office: _____________________________________________________________________

8. Address: ___________________________________________________________________

9. Phone: _____________________________________________________________________

10. Email: ____________________________________________________________________

11. Contract Administrator Name: _______________________________________________

12. Office: ____________________________________________________________________

13. Address: __________________________________________________________________

14. Phone: ____________________________________________________________________

15. Email: ____________________________________________________________________

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G. Describe the nature or portion of the work on the proposed effort to be performed by the business entity being reported and how it applies to the Demolition and Abatement Statement of Work as well as the Exhibit Line Item Number (ELIN) Schedule. Also, estimate the percentage of the total proposed effort to be performed by this entity.

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