3. Past Performance Questionnaire.pdf

Controlled Unclassified Information When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Section L Attachment: Past Performance Questionnaire

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The Space Launch Delta (SLD) 45 of the United States Space Force is in the process of competitively selecting a source for a Fire Protection, Emergency Management, and Emergency Medical Services (FEMS) IV program.

Description of Effort:

Fire Protection: Fire support for structural, aircraft rescue, shipboard firefighting and fire support for mission related launch activities to include technical, confined space, HAZMAT and high angle rescue response IAW compliance regulation on a 24/7 basis.

Emergency Management (EM): Manage all Emergency Operations Center (EOC) activities and maintain integrated plans, programs and execution of emergency response to major accidents, natural disaster, enemy attack, terrorist use of chemical, biological, radiological, nuclear and high yield explosives on a 24/7 basis.

Emergency Medical Services (EMS): EMS to include patient transport IAW Air Force Instruction (AFI) 32-2001, Fire Emergency Services Program, response times. Includes basic and advanced life support, transport to appropriate medical facilities, support launch/flight activities and flight crew contingency care on a 24/7 basis IAW Brevard County EMS protocols.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response be returned to the government no later than proposal due date.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to Patricia Bates at patricia.bates@spaceforce.mil and Abigail Bultman at abigail.bultman@spaceforce.mil or by hand and mailed to the address below.

Mailing Address:

45th Contracting Squadron / PKAA

1201 Edward White II Street

Bldg. 423, Rm. C202

Patrick SFB, FL. 32925- 3238

Attention: Patricia Bates and/or Abigail Bultman

Email Address:

Procuring Contracting Officer (PCO) Patricia Bates, patricia.bates@spaceforce.mil

Administrative Contracting Officer (ACO) Abigail Bultman, abigail.bultman@spaceforce.mil

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Section L Attachment: Past Performance Questionnaire

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Your completed questionnaire will become a part of the official Source Selection records. Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Section 1: Contract Identif ication

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

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B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identif ication

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Section 4: Performance Information

In the tables below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided.

Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the

Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Technical Performance E V S M U N/A

T1. How well did the contractor meet the technical requirements of the specification?

SUPPORTING INFORMATION:

T2. How was the contractor’s effectiveness in developing, delivering and recording training programs for Fire Emergency Services personnel?

T3. How was the contractor’s effectiveness in developing, delivering and recording training programs for Emergency Medical Services personnel?

T4. How was the Contractor performance in providing Structural firefighting efforts?

T5. How was the Contractors compliance with technical requirements and performance standards in providing Launch or Hazardous Material Response (Technician level) efforts?

T6. How was the Contractors compliance with technical requirements and performance standards in providing in providing Basic Life Support (EMT-B) Emergency medical response?

T7. How was the Contractors compliance with technical requirements and performance standards in providing in providing Advanced Life Support (EMT- Paramedic) Emergency medical response with transport?

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T8. How was the Contractors compliance with technical requirements and performance standards in providing in providing Fire Prevention and Public Education Services?

T9. How adequate/effective was the Contractors overall technical performance?

T10. How effective was the contractor regarding interfacing with other Emergency Management functions at the municipal, county, state, federal and DoD and other levels of government?

T11. How effective is the contractor at standing up (staffing and operating) an Emergency Operations Center 24/7 for multiple operational periods?

T12: How effective is the contractor at reviewing operational plans (Comprehensive Emergency Management Plans/Installation Emergency Management Plans and similar planning documents), regulations, publications and other written guidance to ensure compliance and interoperability?

Program Management E V S M U N/A

P1. How adequate/effective did the contractor build effective working relationships in a team environment?

P2. How well did the contractor ensure all contracted activities were accomplished in accordance with contract terms and conditions?

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P3. How adequate/effective were the contractor’s safety procedures including NFPA 1500, Health and Safety Program, OSHA and contract safety and health requirements?

P4. How well did the contractor use metrics, risk management, and other tools to accurately measure and track performance including ACES-IMS, FESAP, MICT, ERC or similar product(s)?

P5. How successfully did the contractor effectively staff key positions and retain key personnel?

P6. How well did the contractor manage quality/effectiveness of subcontracted efforts?

P7. How effective was the contractor’s material management (including Government Furnished Property or Material)?

P8. How effective was the contractor’s management of multiple fire stations under one contract demonstrating they have staffed and supported continuous operations across at least two distinct geographic areas simultaneously?

P9. How well did the Contractor perform in regards to content, accuracy, quality, and timeliness of technical, management, and invoices and other deliverables?

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P10. How effective was the contractor in maintaining continuity of mission support while transitioning/phasing in resources and personnel?

Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations?

☐ Yes ☐ Default ☐ Convenience ☐ Pending Terminations ☐ No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what was promised in the proposal, I [ click and select an item ] award to them today.

REMARKS:

Please provide any additional comments concerning this contractor’s performance, as desired.

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!