HQ0858-21-R-0010_Attachment L-01 PPI Form R3 - 03.11.2021.pdf

HQ0858-21-R-0010

Attachment L-01

FOR SOURCE SELECTION INFORMATION – FAR 2.101 AND FAR 3.104 –

CONTROLLED UNCLASSIFIED INFORMATION (WHEN FILLED IN)

PAST PERFORMANCE INFORMATION (PPI)

HQ0858-21-R-0010

Facilities, Logistics, & Environmental

Instructions:

1. Provide the information requested in this form for each contract reference.

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

3. Limit the number of references submitted and the length of each submission to the limitations set forth in Section L of this solicitation.

A. Company Information:

Offeror Name

(Company/Division):

Address:

Phone Number:

Email:

CAGE Code:

DUNS Number:

B. Contract Specifics:

Contract Title/Description of Effort:

Contract Number:

Email:

Contracting Agency or Customer:

Task Order Number:

Contract Type: (e.g. Firm-Fixed Price, Cost-

Plus-Fixed Fee, T&M, Single Contract or IDIQ)

Original Period of Performance:

If this performance period has changed, explain why:

Initial Contract Value (base only): $

Current/final Contract Value (base and exercised options only):

If Amounts for Initial Contract Cost/Price and Current/final Contract Cost/Price above are different, provide a brief description of the reason:

Approved for Public Release 21-MDA-10725 (4 Mar 21)

FOR SOURCE SELECTION INFORMATION – FAR 2.101 AND FAR 3.104 –

CONTROLLED UNCLASSIFIED INFORMATION (WHEN FILLED IN)

C. Brief Description of Effort: Briefly describe below the scope of effort of the contract and and highlight portions considered most relevant to this procurement.

Performed as ☐Prime or ☐ Subcontractor.

If you performed as a Subcontractor, provide Prime Contractor's information:

Prime Contractors

Name:

Address:

Phone Number:

Email:

D. Completion Date:

Original date:

Current Schedule:

Estimate at Completion:

How Many Times Changed:

Primary Causes of Change:

E. Place of Performance (check all that apply):

- Single Location

- Multiple Locations

- CONUS – Specify City/State:

- OCONUS – Specify Country:

F. Illustrate how your experience on this program applies to any of the following elements:

MCS1 Element #1: Facility Operations and Sustainment Planning; MCS1 Elements #2 and

#3: Procurement Management and Database Management; MCS2 Element #1: Product

Support Management; MCS2 Element #3: Supply Support/Property Accountability; MCS3

Element #1: National Environmental Policy Act (NEPA); MCS3 Element #2:

Environmental Permitting; MCS4 Element #1: Provide Qualified Personnel; and MCS4

Element #3: Problem Resolution Strategy.

FOR SOURCE SELECTION INFORMATION – FAR 2.101 AND FAR 3.104 –

CONTROLLED UNCLASSIFIED INFORMATION (WHEN FILLED IN)

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 related to the prime (define relationship).

H. Provide two (2) points of contact most knowledgeable of the submitted contract. For

Government points of contact may include Program Manager, Project/Task Manager, Procuring Contracting Officer (PCO), Administrating Contracting Officer (ACO), and

Contracting Officer Representative (COR). For commercial contracts, provide two (2) points of contact fulfilling similar roles.

Position (i.e. Program

Manager, PCO, COR, etc.)

Name

Organization

Address

Telephone

Email Address

Position (i.e. Program

Manager, PCO, COR, etc.)

Name

Organization

Address

Telephone

Email Address