Attachment_P4_Past_Performance_Information_Form.docx

PAST PERFORMANCE INFORMATION FORM

FOR OFFICIAL USE ONLY/ SOURCE SELECTION INFORMATION – SEE FAR 2.101, 3.104 AND 42.15

Offeror Name: Role on this Solicitation:

{Select One from Below} Prime, Principal Subcontractor Team Member

Division Name:

PSC: Contract Type:

Project Title: Location of Work:

Agency/Customer Name and Location:

Agency/Customer Program Manager Name:

Title:

Email Address: Phone Number:

Agency/Customer Contracting Point of Contact Name:

Title:

Email Address: Phone Number:

{Select One from Below}

Cost Plus Award Fee, Cost Plus Fixed Fee, Cost Plus Incentive Fee, Cost No Fee, Cost Sharing, Firm Fixed Price, Fixed Price Award Fee, Fixed Price Incentive, Fixed Price Level of Effort, Fixed Price Redetermination

Base

Option 1

Option 2

Option 3

Option 4

Option 5

Total Contract Value: Contract Effort Description:

Demonstrated Systemic Improvement Information: Identify those demonstrated improvement actions taken to resolve any performance issues or problems. Describe the techniques, elements and tools used to correct issues or problems and, if applicable, how these techniques, elements and tools will be employed during performance of this requirement.