Atch 5_Past Performance Questionnaire.docx

CUI

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

FA462524Q1026, Attachment 4 The 509th Contracting Squadron of the Air Force Global Strike Command is in the process of competitively selecting a source for Portable Toilets services on Whiteman AFB.

One of the considerations in proposal evaluation is the verification of the offerors’ past performance on contracts or other work efforts which reflect the offerors’ 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 offerors’ 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 no later than 15 November 2023. This schedule will allow us sufficient time to analyze the data prior to the start of source selection.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to 509CONS.PKA.Services@us.af.mil (Attn: Mrs. Molly Nussbaum). Please call Mrs. Molly Nussbaum at 660-687-5461 if you have any questions. Your completed questionnaire will become a part of the official source selection records.

Your assistance is greatly appreciated. Your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Molly Nussbaum Contracting Officer

Attachment Past Performance Questionnaire

Controlled By: 509 Bomb Wing Controlled By: 509th Contracting Squadron CUI Category: PROCURE Distribution/Dissemination Controls: FED ONLY POC: Molly Nussbaum, molly.nussbaum@us.af.mil, 660-687-5461

Section 1: Contract Identification

3. Reasons for difference (if applicable):

Click or tap here to enter text.

H. Description of work performed:

Type description of work here.

Section 2: Customer or Agency Identification

Section 3: Respondent Identification

Section 4: 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.

1. Developed and maintained a cooperative and productive professional working relationship through all phases of the contract.

Comments:

2. Provided experienced personnel with the technical knowledge to meet contract requirements.

3. Maintained sufficient staffing and equipment to complete the work in an effective and efficient manner.

4. Demonstrated the ability to complete work in a safe and timely manner.

5. Promptly identified problems, hazardous material, or other site issues to the Agency. Proactively provided possible solutions for consideration.

6. Corrected deficiencies in timely manner and corrective action was effective.

7. Discarded all waste or hazardous material in accordance with state, federal, local, and environmental procedures/regulations.

8. How would you rate the contractor’s overall performance on this contract?

9. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain.

☐ Yes ☐ No

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

EXPLANATION:

☐ Yes ☐ No

Additional remarks (these are important; please include comments):

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: 509CONS.PKA.Services@us.af.mil CUI Page 2 of 6