Atch_05,_Performance_Information_Form.pdf

Attachment 5, FA9301-19-R-A013 Page 1 of 2

PERFORMANCE INFORMATION FORM

Solicitation Number: FA9301-19-R-A013

A. Offeror Information:

Name (Company/Division):

CAGE Code: DUNS Number:

If Other than the Prime Offeror, Identify Prime Offeror:

B. Program Title:

C. Contract Specifics:

Contracting Agency or Customer:

Contract Number:

Contract Type:

Period of Performance (include exercised options):

Contract Dollar Value:

Has the contract been entered into the Contractor Performance Assessment Reporting System (CPARS)?

Yes No

D. Brief Description of Contract as ___________ Prime __________Subcontractor

Indicate the type of services provided and highlight portions considered most relevant to Edwards AFB’s wastewater treatment plants operation and maintenance services acquisition to include specific references/paragraph citations to Edwards AFB’s PWS (Attachment 1 of

RFP).

Attachment 5, FA9301-19-R-A013 Page 2 of 2

E. Primary Customer Points of Contact:

For Government contracts, provide the following information for the Program Manager and Contracting Officer. For Commercial contracts, provide equivalent to aforementioned Government positions. Ensure the individuals are currently available to provide past performance information if requested by the Government.

Name: ________________________________________________ Office:

Telephone Number:

E-mail Address: ________________________________________________