ATTACHMENT_2-Past_Project_Form.docx

ATTACHMENT 2

PAST PROJECT FORM

1. Name of Contractor

1a. Solicitation Number: HSHQEC-15-R-00005 (Lease of X-Ray Machines)

2. Complete Name of Government Agency, Commercial Firm, or Other Organization for Which Effort Performed.

3. Complete Address of Entity Named in #2 Above

4. Contract Number or Other Reference

5. Date of Project Award

6a. Total Project Price (to include all options):

6b. Current Annual Estimated Price:

7. Period of Performance (to include all options)

8. Was contractor listed in section 1 the Prime Contractor?

Yes [ ] No [ ] 8a. If “No” was selected for 9, list the % of annual work your firm performed

9. Technical Point of Contact

Name:

Title:

Phone:

Email:

9a. Contracting or Purchasing Point of Contact

Name:

Title:

Phone:

Email:

10. Geographic Location of Work (Country, State or Province, County, City)

11. Contractor Performance Assessment Reporting System (CPARS) Completion: CPARS is a web-enabled application that collects and manages contractor performance assessments. A CPAR report is required to be completed annually through the conclusion of the contract. Once “finalized” CPAR assessments are copied to the Past Performance Informational Retrieval System (PPIRS). Contractors may view their own data in PPIRS at http://www.ppirs.gov/.

Contractor Complete the Following by Checking the Appropriate Box:

□ A “finalized” Contractor Performance Assessment Report IS resident in PPIRS for this contract for the most recently completed performance period.

□ A “finalized” Contractor Performance Assessment Report IS NOT resident in PPIRS for this contract for the most recently completed performance period..

12. Description of Contract Work. In order to establish the relevance of your project to the instant requirement, please describe requirements of your past performance, comparing and contrasting it to that required under this solicitation. Additionally, describe any unique or unusual requirements of the contract, and performance problems or issues encountered under the performance of the contract. For problems/issues noted, describe the method of resolution and/or corrective actions taken. Use a continuation sheet, if necessary.

13. Did this contract require the submission of a subcontracting plan? If so, describe the efforts being made to meet the subcontracting goals contained within the approved plan to include the name(s) of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).