Atch 7 PPQ.pdf

CUI

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

Past Performance Questionnaire – FA3020-22-R-0006 – Grease and Grit Trap Cleaning Services

Attachment 07 CUI Page 1 of 4

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Period of Performance

1. Beginning Date _________ through ____________

C. Contract Scope

1. Quantity (in gallons) of Grease collected under contract: ______________________

2. Quantity (in gallons) of Grit collected under contract: ____________________

3. Quantity (in gallons) of other material collected under contract: _________________

4. If other material collected, what kind of other material: ________________________

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

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

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

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

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

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

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

Attachment 07 CUI Page 2 of 4

E. Other suggested points of contact:

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.

The Contractor: E V S M U N/A

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

SUPPORTING INFORMATION:

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

Attachment 07 CUI Page 3 of 4

The Contractor: E V S M U N/A

3. Followed established performance schedules.

4. Cooperated with customer personnel after award.

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

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

EXPLANATION:

☐ Yes

☐ No

IF THIS WAS A GOVERNMENT CONTRACT:

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).

Attachment 07 CUI Page 4 of 4

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what was promised in his proposal, I [ click and select an item ] award to the contractor today given that I had a choice.

Additional remarks:

[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: jerry.roberts@us.af.mil and todd.raines.3@us.af.mil