HSCG38-15-Q-200097_-_Past_Performance_Questionnaire.doc

HSCG38-15-Q-200097

PAST PERFORMANCE INFORMATION SHEET

The offeror shall use this sheet to provide recent and relevant Past Performance Information. A separate Past Performance/Experience Information Sheet shall be completed for each relevant contract. The Past Performance Information Sheet shall be no more than three (3) pages in length for any contract (reference).

Offeror

Agency or Customer

Include:

(1) Address

(2) Point of Contact (POC)

(3) POC Phone Number

(4) POC Email

(The offeror is responsible for exerting its best efforts to ensure that current information is provided for all individuals.)

Program Title or Contract Number

Contract Type (Firm Fixed Price, Time and Material, etc.)

Period of Performance

Original Contract Value

Current Contract Value

Estimated Value at Completion

If different from Original Contract Value, explain cost difference

Prime or Subcontractor on this effort?

A. Brief Description of Effort:

As a part of this narrative description, highlight portions considered most relevant to the current acquisition; addressing how and to what extent the proposed effort relates to the program identified above.

B. Achievements:

Use this space to address any aspect about this program considered unique. Describe quality awards or certifications that indicate the offeror possesses a high-quality process for developing and producing the product/service required.

Provide any information currently available (letters, metrics, customer surveys, independent surveys, etc.) which demonstrates customer satisfaction with overall job performance and quality of completed product for same or similar type contract.

C. Problems Encountered and Corrective Actions:

The offeror may use this space to summarize contract issues relative to the number and severity of quality deficiencies recorded/contract discrepancy reports issued, cure notices, show cause letters, termination for default or cause, disputes, claims, latent defects; and, corrective actions taken for the contract listed above.

D. Other Information:

The offeror may use this space to provide any additional information relating to the contract.

This Document is Source Selection Sensitive Information IAW FAR 2.101 and 3.104