Atch_13_(L-7)_Past_Performance_Information_Form_(PPIF).pdf

FA9301-16-R-0011 PAVING ID/IQ SOLICITATION

ATTACHMENT 13 (L-7)

PAST PERFORMANCE INFORMATION FORM Page 1 of 2

PAST PERFORMANCE INFORMATION FORM (PPIF)

Instructions: Provide all information requested on this form for each effort being submitted. Provide brief and concise descriptions of your performance on the effort you identify and use a separate form for each effort. Limit the number of past efforts submitted to the limitations set forth in Section L of the solicitation (Standard Form (SF) 1442).

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/Task Order/Job Order Number:__________________________________________________

3. CAGE/DUNS under which Contract/Task Order/Job Order Number was awarded:

4. Contract Type (Check all that apply):

☐ Fixed-Price ☐ ID/IQ ☐ Cost ☐ Other (Specify): ________________

5. Role:

☐ Prime ☐ Subcontractor ☐ Other (Specify): _____________________________

6. Contract Environment:

☐ Military Installation within State of CA ☐ Federal, State, or Local Government Agency within State of CA ☐ Military Installation or Federal, State, or Local Government Agency outside State of CA ☐ Other (Specify): __________________________________________________________________

7. Period of Performance:

From: _______________________ To: ________________________

8. Contract/Order/Project Amount: $_______________________________________________________

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

10. Original Contract $ Value: $_____________________________ (Do not include unexercised options)

11. Current Contract $ Value: $_____________________________ (Do not include unexercised options)

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

D. Brief Description of Effort: (as the) ☐ Prime ☐ Subcontractor ☐ Other (Specify):

ATTACHMENT 13 (L-7)

PAST PERFORMANCE INFORMATION FORM Page 2 of 2

E. Completion Date:

1. Original Date: _______________________________________________________________________

2. Current Schedule: ____________________________________________________________________

3. Estimate at Completion: _______________________________________________________________

4. How Many Times Changed:____________________________________________________________

5. Primary Causes of Change(s):___________________________________________________________

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: ____________________________________________________________________________

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 Paving 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.