6_Past Performance Reference Sheet.pdf

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Attached to
DSN/CSN Repair Bldg. 882 Roof
Solicitation number
FA462626R0014
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This is a Past Performance Reference Sheet template for federal contract solicitation FA4626-26-R-0014. It serves as a questionnaire to be completed by references who have direct experience with an offeror's prior contract performance.

Offerors must submit between three and five past performance references in Volume II of their proposal by 30 June 2026 at 2:00 p.m. Mountain Daylight Time. References must be from projects completed within the five years preceding the solicitation release date and valued at more than $350,000, with scope, size, and complexity similar to the requirements of this solicitation. Section 1 of the form captures contract details including the contract/task order number, performance dates, dollar value, customer name, customer point of contact information, competitive award status, contractor role (prime, subcontractor, or key personnel), subcontractors and teaming partners, and a description of work performed. Section 2 contains 24 sample performance evaluation questions covering management and supervision, personnel hiring and retention, quality control, problem identification and resolution, scheduling, warranty defects, contract changes, project supervision, bonding, cost proposals, government cooperation, small business goals, overall performance rating, and whether cure or show cause notices were issued. Respondents rate contractor performance using a six-point scale: Exceptional (E), Very Good (V), Satisfactory (S), Marginal (M), Unsatisfactory (U), or Not Applicable (N/A). Each rating requires supporting information. The template concludes with yes/no questions regarding cure notices and willingness to award future contracts, followed by respondent signature and date fields.

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Attachment 6 Controlled Unclassified Information (CUI) FA4626-26-R-0014 When completed, this document is Source Selection Information IAW RFO 2.101 and 3.104.

Controlled Unclassified Information (CUI) Page 1 of 6

Past Performance Reference Sheet

In accordance with (IAW) paragraph 4 of Section L of this solicitation, please provide between three (3) and five (5) recent and relevant past performance references. As a reminder, “recent” is defined as “completed projects within the last five (5) years from the date of the release of this solicitation”, and “relevant” is defined as “a project similar in scope, size, and complexity to the requirements of this solicitation and valued more than $350,000.00.” Include rationale supporting your assertion of relevance.

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.

Past performance references must be provided within Volume II – Past Performance of your company’s proposal, which is to be submitted and received no later than 30 June 2026 at 2:00 p.m. Mountain Daylight Time (MDT).

Controlled Unclassified Information (CUI) Page 2 of 6

Past Performance Reference Sheet

Section 1: Past Performance Reference:

a. Contract/Task Order Number:

b. Dates of Performance:

c. Contract Dollar Value:

d. Name of Customer:

e. Name, phone number, and email address of customer POC:

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

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

h. All subcontractors, teaming arrangements, and/or joint venture partners:

i. Description of work performed:

Controlled Unclassified Information (CUI) Page 3 of 6

Note: The following are SAMPLE questions. Past Performance evaluation teams MUST construct a simple and concise Past Performance Questionnaire, tailored to seek out key information tied to the significant aspects of the planned acquisition. Avoid questions that can be answered with a “yes” or “no” but instead include probing and direct questions to draw out the required information desired.

Section 2: Performance Information In the table 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.

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.

Controlled Unclassified Information (CUI) Page 4 of 6

E V S M U N/A

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

SUPPORTING INFORMATION:

2. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Home office participated in solving significant local problems.

5. Followed approved quality control plan.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

8. Provided timely resolution of contract discrepancies.

Controlled Unclassified Information (CUI) Page 5 of 6

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules.

13. Met established project schedules.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

Controlled Unclassified Information (CUI) Page 6 of 6

18. Paid subcontractors/suppliers in a timely manner.

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

20. Cooperated with Government personnel after award.

21. Met or exceeded small business and small disadvantaged business goals set forth in the approved subcontracting plan.

22. How would you rate the contractor's overall performance on this contract?

23. Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain.

EXPLANATION:

☐ Yes

☐ No

24. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

☐ Yes

☐ No

[click and pick the date]

Respondent’s Signature Date

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