Atch 04 Past Performance Questionnaire.docx

Attachment 4 – Past Performance Questionnaire Solicitation # HTC71121RR014

PAST PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Controled Unclassified Information

SECTION 1: CONTRACT IDENTIFICATION

INSTRUCTIONS: The Offeror submitting a proposal to USTRANSCOM in response to solicitation number HTC71121RR014 completes this section prior to sending to the Respondent.

A. Contractor Name: __________________________________________________________________________

B. Contract Title/Number: ______________________________________________________________________

C. Brief Description of Work Performed (include workload estimates):

D. Location (countries) where service was performed under this contract:_________________________________

E. Contractor being evaluated performed as the: ______ Prime or ______ Subcontractor (Mark one)

F. Contract Type: ___ Fixed Price ___ Cost ___ IDIQ ___ Single Award ___ Multiple Award

Other: ______________________________________________________________________________

G. Total Period of Performance (month/year – month/year): __________________________________________

H. Annual Contract Value (amount awarded): _____________________________________________________

I. Total Contract Value (including unexercised options): _____________________________________________

SECTION 2: RESPONDENT INFORMATION

INSTRUCTIONS: The remaining sections are to be completed by Respondent.

The results of this survey will aid the Government in determining whether there is a reasonable expectation that the contractor will successfully perform. Therefore, it is important the responses be candid, factual, and as complete as possible. The contractor will not be provided with this form, once completed, or the name of the respondent.

If you do not have knowledge of, or experience with, the contract referenced above, please forward this Questionnaire to the person who can provide the information. Also, if offeror holds or has held other relevant contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Questionnaires must be returned no later than XXXX USTRANSCOM Acquisition Office via E-mail: barbara.l.wolf11.civ@mail.mil; douglas.d.otten.civ@mail.mil; Please indicate “Performance Survey” in the subject. Note, this information is to be received directly from the respondent and will not be considered if received from the Offeror.

A. Respondent's name: __________________________________________________________________________

B. Respondent's title: ___________________________________________________________________________

C. Customer or agency name: ____________________________________________________________________

D. Respondent's phone number: ___________________________________________________________________

E. Respondent’s Email: _________________________________________________________________________

F. Description of Work Performed. Please mark the appropriate boxes to indicate the services provided under this reference. In the space below, provide workload estimates (such as pounds of cargo, number of passengers or missions flown, etc.) and any other services not listed. Note: If any of the information in Section 1 is incorrect, please provide the correct information here.

Rotary Wing

Fixed Wing

N/A

G. Was contract performance assessed in Contractor Performance Assessment Reporting System (CPARS)?

________ Yes ________ No

NOTE: The Past Performance Information Retrieval System (PPIRS) may be reviewed for the referenced contract as well as responses to this questionnaire. Although you may have filed a CPARS for the contract listed, we appreciate your response to this questionnaire because some of the questions relate to areas not covered by CPARS.

SECTION 3: PERFORMANCE INFORMATION

INSTRUCTIONS: Place a mark in the block that most accurately describes the contractor’s performance or situation.

In responding to the survey, please justify and explain Marginal or Unsatisfactory ratings. As the Respondent, you may be contacted to clarify comments or ratings. In order for the government to review and assess the contractor’s past performance rating, please use the following ratings to describe the offeror’s performance on your contract or project:

Exceptional (E) - Performance met all contract requirements and exceeded many to your company’s (or agency’s) benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

Very Good (VG) - Performance met all contract requirements and exceeded some to your company’s (agency’s) benefit. There were a few minor problems that the contractor resolved in a timely, effective manner.

Satisfactory (S) - Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

Marginal (M) - Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective or was not fully implemented.

Unsatisfactory (US) - Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Unknown (U) - No record of past performance or the record is inconclusive.

Not Applicable (NA) – The requested information was not related to the referenced contract effort.

Rating Comments. Please discuss each response for which you indicated Marginal or Unsatisfactory performance in response to the questions above (use additional sheets, if necessary).

SECTION 4: NARRATIVE QUESTIONS

INSTRUCTIONS: Respond to the questions and provide explanations as necessary.

1. Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations? ________ Yes ________ No

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

2. Would you have any reservations with awarding to this contractor in the future or having them perform one of your most critical and demanding programs? If so, please explain why.

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