Attachment 5 - Past_Performance_Information_FormRev2.docx

PAST PERFORMANCE INFORMATION FORM

28 March 2022

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 or No

D. Brief Description of Contract as ___________ Prime or __________Subcontractor Indicate the type of services provided and highlight portions considered most relevant to the Base Custodial acquisition.

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: FAX Number:

Email Address:

FA9301-22-Q-0011

Attachment 5