Attachment_1_-_Past_Performance_Information_Sheet.docx

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Attached to
Certified Athletic Trainer Single Award Task Order Contract Federal contract opportunity
Solicitation number
N62645-18-R-0039
Issued by
Department of the Navy Bureau of Medicine and Surgery

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Revised - Attachment 1 - Past Performance Information Sheet

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Attachment 1— Past Performance Information Sheet

Solicitation Number: N62645-18-R-0039, Certified Athletic Trainer Services throughout the Western, Southeastern, and Hawaii regions of the United States and Japan

Closing Date: 2:00pm local time on 30 May 2018

The contractor shall complete Section I of the Past Performance Information Sheet and submit it to the customer Point of Contact (POC) for completion of Section II. The customer POC shall submit the entire completed Past Performance Information Sheet (Sections I and II) directly to the offeror for submission as part of Volume I in accordance with Addendum 52.212-1, Section 2.2 of the combined synopsis/solicitation The Government will not consider Past Performance Information Sheets submitted after the closing date and time of the solicitation.

Section I - Completed by Contractor

A. Name of Contractor Submitting Proposal: Click here to enter text.

B. Contract Number: Click here to enter text.

C. Contract Amount: Click here to enter text.

D. Description of Services including qualifications of workers and duties: Click here to enter text.

E. Name of Contractor that Performed Services under the below reference: Click here to enter text.

F. If the names of A & E do not match please describe how this past performance is pertinent. (See Sections L.2.2.2, L.2.2.3, L.2.2.4 and L.2.2.5 of the solicitation) Click here to enter text.

Section II - Completed by Customer

Submit the entire completed Past Performance Information Sheet (Sections I and II) to the offeror to be returned as part of the completed proposal. Ensure the Past Performance Information Sheet is electronically signed. Do not send the Past Performance Information Sheet to the Contracting Officer directly.

Please complete for all Certified Athletic Trainer or equivalent services as referenced in Addendum 52.212.1 provided within the last 5 years for the contract(s) listed below.

Contract Number/Task Order
Specific Labor Category
Period of Performance
Level of effort or number of Contract Workers Provided
Example: N62645-12-D-0000
Certified Athletic Trainer
10/01/16 – 09/30/17

Comments required in additional remarks for ALL marked NO

A. QUALITY OF SERVICE:

(1) The Contractor provided a service that conformed to contract requirements, specifications, and standards of good workmanship. Choose an item.

(2) The Contractor utilized personnel that were appropriate to the effort performed.Choose an item.

(3) The Contractor submitted accurate invoices and reports on a timely basis. Choose an item.

B. SCHEDULE AND COST CONTROL:

(1) The tasks required under this effort were performed in a timely manner and in accordance with the period of performance of the contract. Choose an item.

(2) The Contractor performed the effort within the estimated cost/price. Was the Contractor effective in forecasting/managing/controlling cost? Did they have cost growth or over runs? Choose an item.

C. BUSINESS RELATIONSHIPS:

(1) The Contractor demonstrated effective management over the effort performed. Choose an item.

(2) The Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) were apprised of any issues. Choose an item.

(3) The Contractor presented information and correspondence in a clear, concise and businesslike manner. Choose an item.

(4) The Contractor cooperated with the Government in providing flexible, proactive, and effective solutions to critical issues. Choose an item.

D: OVERALL PERFORMANCE:

(1) How would you describe the overall performance by the Contractor? Choose an item.

(2) Would you consider working with the Contractor again in the future? Choose an item.

Why or why not? Click here to enter text.

ADDITIONAL REMARKS: (Comments required for ALL items marked NO)

Click here to enter text.

Individual completing the survey:

Name ____________________________ Title ___________________ Phone __________________________

____________________________________ Click here to enter a date.

Signature

Alternate Point of Contact:

Name ____________________________ Title ___________________ Phone __________________________

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