ePS_RFP_Attach_17_Gate Form_Past Performance_20170215.docx
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- N00039-17-R-0002
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ePS Gate Form: Past Performance electronic Procurement System Request for Proposal Attachment 17: Gate Form- Past Performance
ACAT 1
Dated 17 February 2017
Distribution Notice A: Approved for public release; distribution is unlimited.
1. PAST PERFORMANCE #1:
Offeror Name
Offeror CAGE Code / DUNS #
Program/Project Name
Program/Project Location
Client/Depart/Agency Name
Contracting Activity Name
Contracting Activity Address
| Contracting Activity Type |
| |_| Government |_| Commercial |_| Other |
Contracting Officer Information (Name, Title, Phone, Email)
Contracting Officer’s Representative Information (Name, Title, Phone, Email)
Client Program/Project Manager (Name, Title, Phone, Email)
Contract # and Type
| Offeror Contracting Role |
| |_| Prime Contractor |
|_| 1st Tier Subcontractor
|_| 2nd Tier Subcontractor or lower
Awarded Contract Price
Final or Projected Final Contact Price
Awarded Period of Performance
Final Period of Performance
| Performance Documented in CPARS |
| |_| Yes |_| No |_| Other: (Provide system name if other) |
A brief description of contract scope (250 words or less):
A detailed description of how the program/project/contract is relevant to the requirements of the solicitation (500 words or less):
A detailed description of the Offeror’s program/project/contract performance to include qualitative and quantitative performance measures (if available) (500 words or less):
Brief description of events where the Offeror did not meet the schedule or technical requirement(s); Provide a brief explanation of the reason(s) for the shortcoming(s) and any corrective action(s) taken to include resulting effects. The Offerors shall indicate if any of the contracts listed were terminated and the type and reasons for the termination (250 words or less):
2. PAST PERFORMANCE #2:
Offeror Name
Offeror CAGE Code / DUNS #
Program/Project Name
Program/Project Location
Client/Depart/Agency Name
Contracting Activity Name
Contracting Activity Address
| Contracting Activity Type |
| |_| Government |_| Commercial |_| Other |
Contracting Officer Information (Name, Title, Phone, Email)
Contracting Officer’s Representative Information (Name, Title, Phone, Email)
Client Program/Project Manager (Name, Title, Phone, Email)
Contract # and Type
| Offeror Contracting Role |
| |_| Prime Contractor |
|_| 1st Tier Subcontractor
|_| 2nd Tier Subcontractor or lower
Awarded Contract Price
Final or Projected Final Contact Price
Awarded Period of Performance
Final Period of Performance
| Performance Documented in CPARS |
| |_| Yes |_| No |_| Other: (Provide system name if other) |
A brief description of contract scope (250 words or less):
A detailed description of how the program/project/contract is relevant to the requirements of the solicitation (500 words or less):
A detailed description of the Offeror’s program/project/contract performance to include qualitative and quantitative performance measures (if available) (500 words or less):
Brief description of events where the Offeror did not meet the schedule or technical requirement(s); Provide a brief explanation of the reason(s) for the shortcoming(s) and any corrective action(s) taken to include resulting effects. The Offerors shall indicate if any of the contracts listed were terminated and the type and reasons for the termination (250 words or less):
3. PAST PERFORMANCE #3:
Offeror Name
Offeror CAGE Code / DUNS #
Program/Project Name
Program/Project Location
Client/Depart/Agency Name
Contracting Activity Name
Contracting Activity Address
| Contracting Activity Type |
| |_| Government |_| Commercial |_| Other |
Contracting Officer Information (Name, Title, Phone, Email)
Contracting Officer’s Representative Information (Name, Title, Phone, Email)
Client Program/Project Manager (Name, Title, Phone, Email)
Contract # and Type
| Offeror Contracting Role |
| |_| Prime Contractor |
|_| 1st Tier Subcontractor
|_| 2nd Tier Subcontractor or lower
Awarded Contract Price
Final or Projected Final Contact Price
Awarded Period of Performance
Final Period of Performance
| Performance Documented in CPARS |
| |_| Yes |_| No |_| Other: (Provide system name if other) |
A brief description of contract scope (250 words or less):
A detailed description of how the program/project/contract is relevant to the requirements of the solicitation (500 words or less):
A detailed description of the Offeror’s program/project/contract performance to include qualitative and quantitative performance measures (if available) (500 words or less):
Brief description of events where the Offeror did not meet the schedule or technical requirement(s); Provide a brief explanation of the reason(s) for the shortcoming(s) and any corrective action(s) taken to include resulting effects. The Offerors shall indicate if any of the contracts listed were terminated and the type and reasons for the termination (250 words or less):
N00039-17-R-0002
Solicitation Number: N00039-17-R-0002
| Attachment No. 17 |
| Page 3 of 3 |
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