Att L1 PPI Form 20 Feb 20.docx

HQ0858-20-R-0001

Attachment L1

PAST PERFORMANCE INFORMATION (PPI)

HQ0858-20-R-0001

Contracts, Compliance, Cost/Price, and Operations (C3PO)

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:

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

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 MCS1 Element #2, MCS1 Element #3; MCS2 Element #1; and MCS3 Element #1.

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.

Organization

Address

Telephone

Email Address

Organization

Address

Telephone

Email Address

FOR SOURCE SELECTION INFORMATION – FAR 2.101 AND FAR 3.104 –

FOR OFFICIAL USE ONLY (WHEN FILLED IN)