Attachment_F_-_PRESENT_AND_PAST_PERFORMANCE_INFORMATION_FORM.pdf

ATTACHMENT F

26 February 2016

PRESENT AND PAST PERFORMANCE INFORMATION FORM

FOR THE

DEFENSE THREAT REDUCTION AGENCY’S CONTINGENCY AND EXERCISE

DEPARTMENT (DTRA J10CE) TECHNICAL SUPPORT GROUP PERSONNEL

SUPPORT CONTRACT

SOLICITATION NUMBER: HDTRA116R0007

The information requested in this form is to assess a company’s present and past performance.

Provide frank, concise comments regarding your performance on the contracts you identify.

Provide a separate form for each contract/program submitted.

1. Offeror Name (Company/Division): __________________________________________

CAGE Code: __________________________________________

DUNS Number + 4: __________________________________________

2. Program Title: __________________________________________

3.A. Contract Specifics: (For Prime contractor submissions)

3.A.1. Contract Information

a. Contracting Agency or Customer __________________________________________

b. Prime Contract Number __________________________________________

c. Contract Type __________________________________________

d. Period of Performance __________________________________________

f. Original Contract $ Value ________________ (Do not include unexercised options)

g. Current Contract $ Value ________________ (Do not include unexercised options)

h. Total Contract $ Value ________________ (Include unexercised options)

i. If amounts for (f) and (g) above are different, provide a brief description of the reason:

j. Percentage of effort performed by Prime ___________________

k. Number of Prime FTE’s performing on this effort ___________________

l. Number of Sub-Contracts for this effort ___________________

3.A.2. Points of Contact:

(For Government contracts, provide current information on all three individuals. For commercial contracts, provide points of contact fulfilling these same roles.)

a. Prime Program Manager:

Name __________________________________________

Office __________________________________________

Address __________________________________________

Telephone __________________________________________

E-mail __________________________________________

b. Contracting Officer:

Office __________________________________________

Address __________________________________________

c. Administrative Contracting Officer (if applicable):

Office __________________________________________

Address __________________________________________

3.B Contract Specifics: (For Sub-contractor submissions)

3.B.1. Contract Information

a. Contracting Agency or Customer __________________________________________ of the Prime Contract __________________________________________

b. Prime Contractor __________________________________________

c. Prime Contract Number __________________________________________

d. Sub Contract Number __________________________________________

e. Sub Contract Type (T&M, LOE, etc) __________________________________________

f. Period of Performance __________________________________________

g. Original Sub Contract $ Value ________________ (Do not include unexercised options)

h. Current Sub Contract $ Value ________________ (Do not include unexercised options)

i. Total Sub Contract $ Value ________________ (Include unexercised options)

j. If amounts for (f) and (g) above are different, provide a brief description of the reason:

k. Percentage of Prime contract performed by your company ___________________

l. Number of FTE’s your company provides for this effort ___________________

3.B.2. Points of Contact:

(For Government contracts, provide current information on all three individuals. For commercial contracts, provide points of contact fulfilling these same roles.)

a. Sub-contractor Program Manager:

Office __________________________________________

Address __________________________________________

b. Prime Contractor Program Manager:

Office __________________________________________

Address __________________________________________

c. Sub Contracting Officer:

Office __________________________________________

Address __________________________________________

d. Prime Contracting Officer:

Office __________________________________________

Address __________________________________________

c. Administrative Contracting Officer (if applicable):

Office __________________________________________

Address __________________________________________

The following question shall be completed for all references

1. Explain how your experience on this referenced contract/program demonstrates the operational, technical, training and exercise support requirements of this solicitation in accordance with the SOW. Utilize the Scope listed in paragraph 1.0 of the SOW as a guide.

Submit this form via email to dtra.belvoir.j4-8c.list.tsg-support@mail.mil. If you have classified

(up to SECRET) past performance information you wish to provide, send an email to the above address and a classified email address will be provided.

mailto:dtra.belvoir.j4-8c.list.tsg-support@mail.mil