Attachment 2: Past Performanceand Experience Form v4

ATTACHMENT 5 – PAST PERFORMANCE AND EXPERIENCE FORM

INSTRUCTIONS

This is a cover page and does not count against the page limitations. Offeror input is prohibited on the cover page. Offerors shall provide responses to all items in the below tables in the “Offeror Response” columns ONLY. Offerors shall not revise the information in the “Contract Reference Required Information” columns, add rows to the tables, change the font size, or make any other changes or manipulate this document in any fashion. However, offerors may change the height of the rows if needed to ensure the offeror’s response properly fits in the designated space. Note, the government will NOT re-manipulate the row height to ensure the offeror’s entire response is visible. It is incumbent on the offeror to ensure their entire response is properly displayed.

[END OF COVER PAGE]

[THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK]

Contract Reference #1
Contract Reference Required Information
Offeror Response
Title of Effort

Government or commercial contracting activity Point of Contact (POC), telephone number, and email. Note, the government may send a Past Performance Questionnaire to the customer POC listed for each reference. As such, offerors are encouraged to ensure they submit the most up-to-date customer contact information.

Name, UEI, and CAGE code of company who performed the effort

Was performance as a Prime or Subcontractor?

Contract/Purchase Order (PO)/Blanket Purchase Agreement (BPA)/Indefinite Delivery Indefinite Quantity (IDIQ) Number

BPA Call/Task Order (TO)/Delivery Order (DO) Number

Contract Type
(Firm Fixed Price, Labor Hour, Time & Material, etc.)

Date of Award

Period of Performance Inclusive of All Options
If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the performance period for the duration of the subcontractor effort or the BPA Call/TO/DO.

Total Value of Contract Inclusive of All Options
If the effort was performed as a subcontractor or at a BPA Call/TO/DO level, provide the applicable dollar value of the work performed as opposed to a total contract/ceiling value.

Number of full time employees (FTEs) working on the contract or number of X-Rays performed.

Labor Categories (LCATs) performed under the effort.

Contract Reference #1 – Predecessor Company Explanation Contract Reference Required Information
As noted in the RFP, offeror’s may also submit past performance information for predecessor companies. Offerors must explain the difference between the primary offering entity and the predecessor company when submitting past performance information for predecessor companies.