PastPerformanceInformationForm.doc

PAST PERFORMANCE INFORMATION FORM

Form ___ of ___

Name of Offeror:

Contract Number, order number, or identifier:

Customer Name & Location:

Customer Point of Contact (Name & Title):

Telephone Number (PLEASE VERIFY):

and e-mail address

Total dollar amount for this effort during the past five (5) years:

(For ordering vehicles, show both the annual estimated contract amount and the amount of orders actually performed):

(Show calendar year and dollars)

Number of personnel (FTE) performing per year (avg.):

To:

Detailed description of the work performed sufficient to demonstrate the relevance of the reference to the solicitation:

Cost Control/Quality/Timely Performance/Customer Satisfaction/CorrectiveActions (if any):

a. Did contractor perform in compliance with contractual performance requirements? Yes No*

b. Did contractor meet overall cost/price estimates while meeting contract requirements? Yes No*

c. Did contractor employ effective corrective actions and improve performance/quality? Yes No*

d. Were all items (including products, services, reports, etc) delivered within the original contract schedule? Yes No*

e. Were you satisfied with services the contractor provided? Yes No*

f. Was/is any part of this contract terminated for default and/or in litigation? Yes* No NOTE: An explanation must accompany all answers with an asterisk (*). Describe any corrective action(s) initiated to solve any of the above-described problems/deficiencies on this contract. Discuss the success of the corrective action(s) taken.