Atch_10_(L-6),_Past_Performance_Information_Form_(PPIF).docx

FA9301-17-R-0008 PAINTING AND COATINGS ID/IQ SOLICITATION

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). Each form cannot exceed the page limitations set forth in Section L 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/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. Performance Period (as agreed on the awarded contract/task order/job order [e.g. “90 calendar days after Notice to Proceed issuance” or “90 calendar days after award”]): ____________________________

8. Notice to Proceed Start Date: _______________________

9. Contract/Order/Project Amount: $_______________________________________________________

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

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

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

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

D. Completion Date:

1. Notice to Proceed end date: _________________________

2. Current Progress (percentage of completion if effort is on-going): _________________________

3. Actual Effort closeout date (if different from Notice to Proceed end date): ______________________

4. Number of Modifications that resulted in a new completion date: ______________________________

5. Cause for each modification that resulted in a new completion date: ____________________________

E. 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: ____________________________________________________________________________

F. Estimate the percentage of the total proposed effort to be performed by the Offeror. _____________%

G. Describe the actual work performed under the effort (contract/task order/job order).

FA9301-17-R-0008 PAINTING AND COATINGS ID/IQ SOLICITATION

ATTACHMENT 10 (L-6)

PAST PERFORMANCE INFORMATION FORM Page 2 of 2