Sol_Doc_75F40125R00037_Attachment 11 - Past Performance Worksheet.docx
DOCX document 21 KB Posted
- Attached to
- Access to Outpatient Longitudinal Data IDIQ Federal contract opportunity
- Solicitation number
- 75F40125R00037
About this file
This document is a Past Performance Worksheet template for a federal contract opportunity (Solicitation Number: 75F40125R00037) for Access to Outpatient Longitudinal Data IDIQ issued by the Department of Health and Human Services Food and Drug Administration. The template provides a structured format for offerors to document three past performance examples, including detailed sections for contract information such as contract type, action type, total contract value, contracting officer contacts, and a narrative description of performance.
The solicitation is an unrestricted multiple-award IDIQ contract with anticipated two awards, with a minimum of one reserved for a small business concern. The NAICS code is 541519 with a small business size standard of $34 million or 150 employees. Key requirements include active SAM.gov registration, and offerors must submit proposals for both the IDIQ and Task Order #1 concurrently to be considered eligible. The government will evaluate proposals based on technical, price, and other factors to determine the best value, with small business program eligibility requirements applying.
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Text version
ATTACHMENT 11: PAST PERFORMANCE WORKSHEET
Past Performance Example #1
Offeror name and SAM UEI
Name and SAM UEIs of prime Contractor and Subcontractors, if applicable
| Name of contracting activity/customer |
| ☐ Government agency: (describe) |
☐ Commercial customer ☐ Other: (describe)
Contract/order title
Contract/order number
Period of performance, inclusive of options
| Contract type | |||
| ☐ Firm-Fixed-Price | ☐ Labor-Hour | ||
| ☐ Cost-Reimbursement | ☐ Time-and-Materials |
☐ Other: (describe)
| Action type | |||
| ☐ IDIQ | ☐ Standalone Contract | ||
| ☐ BPA | ☐ Purchase Order | ||
| ☐ DO/TO | ☐ Other: (describe) |
| If IDIQ or BPA, how many Delivery Orders/Task Orders have been issued to date? How many Delivery Orders/Task Orders have been concurrent? |
| DOs/TOs issued to date: (#) |
DOs/TOs issued concurrently: (#)
| Total contract value and total subcontract value, inclusive of options |
| Total Contract Value, inclusive of options: ($) |
Total Subcontract Value, inclusive of options: ($)
| Contracting Officer contact information |
| Name: |
Phone #:
E-mail:
| Contracting Officer’s Representative/Project Officer contact information |
| Name: |
Phone #:
E-mail:
Narrative description of how the example was successfully performed as well as whether there were any performance issues identified and how those issues were addressed or mitigated
Past Performance Example #2
Offeror name and SAM UEI
Name and SAM UEIs of prime Contractor and Subcontractors, if applicable
| Name of contracting activity/customer |
| ☐ Government agency: (describe) |
☐ Commercial customer
Contract/order title
Contract/order number
Period of performance, inclusive of options
| Contract type | |||
| ☐ Firm-Fixed-Price | ☐ Labor-Hour | ||
| ☐ Cost-Reimbursement | ☐ Time-and-Materials |
☐ Other: (describe)
| Action type | |||
| ☐ IDIQ | ☐ Standalone Contract | ||
| ☐ BPA | ☐ Purchase Order | ||
| ☐ DO/TO | ☐ Other: (describe) |
| If IDIQ or BPA, how many Delivery Orders/Task Orders have been issued to date? How many Delivery Orders/Task Orders have been concurrent? |
| DOs/TOs issued to date: (#) |
DOs/TOs issued concurrently: (#)
| Total contract value and total subcontract value, inclusive of options |
| Total Contract Value, inclusive of options: ($) |
Total Subcontract Value, inclusive of options: ($)
| Contracting Officer contact information |
| Name: |
Phone #:
E-mail:
| Contracting Officer’s Representative/Project Officer contact information |
| Name: |
Phone #:
E-mail:
Narrative description of how the example was successfully performed as well as whether there were any performance issues identified and how those issues were addressed or mitigated
Past Performance Example #3
Offeror name and SAM UEI
Name and SAM UEIs of prime Contractor and Subcontractors, if applicable
| Name of contracting activity/customer |
| ☐ Government agency: (describe) |
☐ Commercial customer
Contract/order title
Contract/order number
Period of performance, inclusive of options
| Contract type | |||
| ☐ Firm-Fixed-Price | ☐ Labor-Hour | ||
| ☐ Cost-Reimbursement | ☐ Time-and-Materials |
☐ Other: (describe)
| Action type | |||
| ☐ IDIQ | ☐ Standalone Contract | ||
| ☐ BPA | ☐ Purchase Order | ||
| ☐ DO/TO | ☐ Other: (describe) |
| If IDIQ or BPA, how many Delivery Orders/Task Orders have been issued to date? How many Delivery Orders/Task Orders have been concurrent? |
| DOs/TOs issued to date: (#) |
DOs/TOs issued concurrently: (#)
| Total contract value and total subcontract value, inclusive of options |
| Total Contract Value, inclusive of options: ($) |
Total Subcontract Value, inclusive of options: ($)
| Contracting Officer contact information |
| Name: |
Phone #:
E-mail:
| Contracting Officer’s Representative/Project Officer contact information |
| Name: |
Phone #:
E-mail:
Narrative description of how the example was successfully performed as well as whether there were any performance issues identified and how those issues were addressed or mitigated
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