Attachment 0003 - Performance Questionnaire_29 Jan 21.pdf

ATTACHMENT 0003 – PERFORMANCE QUESTIONNAIRE

W519TC-23-R-0095

Per Section L of the RFP, Offerors are hereby put on notice that this is the single opportunity to adequately address any negative past performance submitted in response to this RFP. The Government will not be giving the Offeror an additional opportunity to address negative past performance information during evaluations.

INSTRUCTIONS:

A separate questionnaire shall be provided for the Prime, for each proposed subcontractors performing 20% or more of the effort or who are expected to perform critical performance task(s).

• For Prime BOA holders and their subcontractors complete this form for the Recency time frame defined within this RFP.

In order to verify the recency and relevancy of any information provided, please also provide the following information for each contract referenced below:

• Description of effort performed under this contract

• Functional areas performed under this contract: Transportation/Supply/Maintenance

• Average Annual Dollar Value (Note: If contract reference provided is for work performed as a Prime under a Government contract, provide the total obligation to date divided by the years of contract performance to date. If contract reference is for work performed as a subcontractor on a Government contract, provide the total obligation to date divided by the years of subcontract performance to date.)

• Contractor’s Role in the Performance of this contract (Prime/Sub)

• Place(s) of Performance

• Period of Performance (Start and End dates)

COMPANY NAME: _____________________________

1. Has the company listed above had any relevant contracts where it experienced performance problems during the timeframe outlined above? If yes, provide the information below for each separate issue, and attach copies of any Level III CARs, Cure Notices, Level III Nonconformance Reports (NCRs) or Show Cause Letters received. Please attach extra pages as necessary.

___ YES ___ NO

a. Contract Number

b. Brief description of issue

c. Corrective actions taken to avoid recurrence of the problem

d. Extent to which corrective action has been successful

e. Mitigation plan of how to prevent future issues

f. POC(s) who can confirm the success of corrective measures

2. Has the company listed above had any recent and relevant contracts Terminated for Default or

Terminated for Cause, in whole or in part, during the timeframe outlined above? If yes, provide the information below for each termination. Please attach extra pages as necessary.

___ YES ___ NO

a. Contract Number

b. Type of Termination

c. Reason for Termination

d. POC(s) to verify the information provided