Attach 3 - Past Performance Questionnaire Aerobics.docx

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

Attachment: Past Performance Questionnaire The 673 Contracting Squadron (CONS) is in the process of competitively selecting a source for Aerobics Instruction Services.

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 no later than 23 December 2021. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to the point of contacts listed below. 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.

Signature Contracting Officer

1 Atch : Past Performance Questionnaire

Section 1: Contract Identification

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. Period of Performance:

G. Total Contract Dollar Value:

H. Brief Description of work performed:

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,):

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:

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.

Aerobics

Spinning

Yoga

Pilates

Water Aerobics

Other

Comments:

Class Instructed

(Fill-In)

Certified Instructor

Certification

Comments:

Classes Started On Time

Comments:

Performance Rating

Overall Performance

Comments:

Definition of EXCEPTIONAL: Performance meets contractual requirements and exceeds many to the Agency/Customer's benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.

Definition of VERY GOOD: Performance meets contractual requirements and exceeds some to the Agency/Customer's benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.

Definition of SATISFACTORY: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear, or were, satisfactory.

Definition of MARGINAL: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions. The Contractor's proposed actions appear only marginally effective, or were not fully implemented.

Definition of UNSATISFACTORY: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor's corrective actions appear or were ineffective.

Please address the following questions regarding the overall quality of the contract.

How many classes (Quantity) were awarded annually on the contract? _________Classes How many training classes were lost or required re-performance due to instructor no shows or vendor cancellations? If unknown, Mark “X” in the unknown box.

Classes Lost

Requiring Re-performance

Based on the definitions above, please select an overall quality assessment rating.

Overall Quality Assessment

Rating

Comments:

Additional remarks:

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address:

Attn: 673 CONS/PKB C/o Mrs. Angela Gosizk and Mr. Daniel Swoyer 10480 Sijan Ave, Ste. 370 Joint Base Elmendorf-Richardson, Alaska 99506

FAX to: DO NOT FAX

E-Mail to: angela.gosizk@us.af.mil and