RFP_Attachment_3_PPI_Request_Form.docx

Source Selection Information - See FAR 2.101 & 3.104. For Official Use Only

RFP ATTACHMENT 3

Past Performance Information Past Performance Factor

Contractor:

Contract Number:

Contract Type:

Program Title:

Short Title:

Cage Code:

Contracting Agency/Customer:

DUNS Number:

Delivery or Task Order:

Description of Effort as: Select Prime, Sub, Joint Venture, or Other (explain)

Contract Dollar Value—Original: $ Current: $ Explain the differences in contract values, if applicable:

Period of Performance Start Date: Original End Date: Current End Date:

Explain the differences in Period of Performance, if applicable:

Recency: Insert “Yes” or “No” based on the definition of recency in your RFP.

Customer Points of Contact

Program Manager’s Name:

Office:

Address:

Telephone:

FAX:

Contracting Officer’s Name:

Office:

Address:

Telephone:

FAX:

Other POC Name and Position:

Office:

Address:

Telephone:

FAX:

Narrative per 52.212-1, section 5.0 Volume III - Past Performance:

Updated as of 23 May 2016 2