Attachment 28 Performance Information.pdf

Attachment 28, Performance Information

PERFORMANCE INFORMATION (PI) WORKSHEET

Provide the information requested in this form for each contract/program (citation) being described.

Provide frank, concise comments regarding your performance on the contracts you identify. Provide a separate completed form for each contract/program submitted. Limit the length of each submission and the number of citations submitted to the limitations set forth in Attachment 22 revision 1.

A. Offeror Name (Company/Division): _____________________________________________________ CAGE Code: _______________________________

UEI:______________________________________

DUNS Number: _____________________________ Program/Contract Title: ________________________________________________________________

Offeror's Role in Contract (e.g., Prime, Sub, Partner, etc.):

If Other than the Prime Offeror, Identify Prime Offeror:

(NOTE: If the company or division performing this effort is different than the offeror or the relevance of this effort is impacted by any company/corporate organizational change, note these changes.)

B. Program Title: ______________________________________________________________________

C. Contract Specifics:

01. Contracting Agency or Customer: ______________________________________________________

02. Contract Number: __________________________________________________________________

03. Task/Purchase Order Number (if any):

04. Contract Type (e.g., Firm-Fixed Price, Cost Plus, Time and Material, etc.):

05. Original Period of Performance (Start & Stop Dates including exercised options):

06. Current Period of Performance (Start & Stop Dates including exercised options):

07. If Amounts for 5 and 6 above are different, provide a brief description of the reason:

08. Original Contract Value ($) to include base and option periods; specify only the value of the portion performed by the offeror:

09. Current/Final Contract Value ($) to include base and option periods; specify only the value of the portion performed by the offeror:

10. If Amounts for 8 and 9 above are different, provide a brief description of the reason:

11. Has the contract been entered into the Contractor Performance Assessment Reporting System (CPARS)? Yes or No

12. Average number full time equivalents on contract employed and supervised by the Offeror:

13. Location(s) of Contract Performance:

D. Brief Description of Effort as ___ Prime or ___ Subcontractor (Please indicate the type of services provided (reference Tasks in Section A), highlight portions considered most relevant to the MARVel PWS to include PWS paragraph citations.

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.)

01. Program Manager (PM) Name: ________________________________________________ Office _______________________________________ Address _____________________________________

Telephone ___________________________________ Email _______________________________________

02. Contracting Officer (CO) Name: ________________________________________________ Office _______________________________________

Address _____________________________________

Telephone ___________________________________ Email _______________________________________

03. Administrative Name* ___________________________________________________ Contracting Officer Office _______________________ Address _____________________________________

Telephone ___________________________________ Email _______________________________________ *If administered by other than CO.

F. Address any technical (or other) area about this contract/program considered unique.

G. Describe the nature or portion of the work on the proposed effort to be performed by the business entity being reported here. Also, estimate the percentage of the total proposed effort to be performed by this entity and whether this entity will be performing as the prime, subcontractor, or a corporate division.

H. Additional comments or continuation (must reference section above):

(End of Form)