Draft Atch 4 - Past Performance Information Sheet.pdf

HQ0147-09-R-0006

Attachment 4

PAST PERFORMANCE INFORMATION

Provide the information requested in this form for each contract/program 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 number of past efforts submitted and the length of each submission to the limitations set forth at Section L of this solicitation.

A. Offeror Name (Company/Division): ____________________

CAGE Code: ____________________

DUNS Number: ____________________

(NOTE: If the company or division performing this effort is different than the offeror or the relevance of this effort to the instant acquisition is impacted by any company/ corporate organizational change, note those changes. Refer to the "Organizational

Structure Change History" you provided as part of your Past Performance Volume).

B. Program Title: ____________________

C. Contract Specifics:

1. Contracting Agency or Customer _________________________________________

2. Contract Number __________________________

3. Contract Type __________________________

4. Period of Performance __________________________

5. Original Contract $ Value _________________ (Do not include unexercised options)

6. Current Contract $ Value _________________ (Do not include unexercised options)

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

D. Brief Description of Effort as __Prime or __Subcontractor

(Please indicate and highlight portions considered most relevant to current acquisition)

E. Completion Date:

1. Original date: ____________________

2. Current Schedule: ____________________

3. Estimate at Completion: ____________________

4. How Many Times Changed: ____________________

5. Primary Causes of Change:_______________________________________

HQ0147-09-R-0006

Attachment 4

F. 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).

1. Quality Assurance Person and/or Name _____________________

Site Manager Office _____________________

Address____________________

Telephone__________________

FAX Number_______________

Email: _____________________

2. Administrative Name _____________________

Contracting Officer: Office ____________________

Address____________________

Telephone__________________

FAX Number_______________

Email: _____________________

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

H. For each of the applicable subfactors under the Technical and Management factors in

Section M, illustrate how your experience on this program applies to that subfactor.

I. Specify, by name, any key individual(s) who participated in this program and are proposed to support the instant acquisition. Also, indicate their contractual roles for both acquisitions.

J. Include relevant information concerning your compliance with FAR 52.219-8, Utilization of Small Business Concerns, on the contract you are submitting.

K. Identify whether a subcontracting plan was required by the contract you are submitting. If one was required, identify, in percentage terms, the planned versus achieved goals during contract performance. If goals were not met, please explain.

L. 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 related to the prime (define relationship).