Attachment-3_Chem_Toilet_Past_Performance_Questionnaire.pdf

Past Performance Questionnaire

The Directorate of the Air Force at Edwards Air Force Base, CA is in the process of competitively selecting a source for a Chemical Toilet and Septic Tank program. All operations required to furnish and service chemical toilets and clean/pump septic tanks as defined in this Performance-based Work Statement (PWS) at Edwards Air Force Base (EAFB) Main Base and Air Force Research Laboratory (AFRL) and Air Force Plant 42 (AFP42) in Palmdale, California.

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 09 June 2020. 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 Ms. Denina Solomon at denina.solomon@us.af.mil and CC Mr. Joshua P. Vasquez at joshua.vasquez.5@us.af.mil. Please call Ms. Denina Solomon at 661-277-9659 prior to emailing or if you have any questions. 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 acquisition.

Signature Joshua P. Vasquez Procuring Contracting Officer

1 Attachment Past Performance Questionnaire

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS AIR FORCE TEST CENTER (AFTC)

EDWARDS AIR FORCE BASE CALIFORNIA

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

16 March 2020 mailto:denina.solomon@us.af.mil mailto:joshua.vasquez.5@us.af.mil

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. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

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

L. 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.

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

16 March 2020

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:

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.

G 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.

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

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 G S M U N/A

1. Chemical toilets are placed, picked-up, and/or sanitized as scheduled.

SUPPORTING INFORMATION:

2. Able to secre chemical toilets to withstand winds up to 70 miles per hour.

SUPPORTING INFORMATION:

3. Submitted an effective quality control plan.

SUPPORTING INFORMATION:

4. Provided effective quality control and/or inspection procedures to meet contract requirements during the contract period.

SUPPORTING INFORMATION:

5. Followed Federal, State, and Local regulations and comlied with safety requirements..

SUPPORTING INFORMATION:

6. Corrected deficiencies in a timely manner and pursuant to their quality control procedures.

SUPPORTING INFORMATION:

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

The Contractor: E G S M U N/A

7. Identified problems as they occurred and suggested solutions.

SUPPORTING INFORMATION:

8. Provided timely resolution of contract discrepancies.

SUPPORTING INFORMATION:

9. Responsive to contract changes.

SUPPORTING INFORMATION:

10. Provided adequate supervision.

SUPPORTING INFORMATION:

11. Has successfully provided chemical toilets and hand wash stations for a special event with approximately 100,000 visitors per day.

SUPPORTING INFORMATION:

12. Able to respond to emergency situation (including weekends) within four (4) hours.

SUPPORTING INFORMATION:

13. Hand wash stations are fully functional (to include water) supplied with paper towels and hand soap.

SUPPORTING INFORMATION:

14. How would you rate the contractor’s overall perfomance on this contract?.

SUPPORTING INFORMATION:

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

The Contractor: E G S M U N/A

15. Septic Tanks are serviced within twenty-four (24) hours of notification.

SUPPORTING INFORMATION: YES/NO

16. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks”.

SUPPORTING INFORMATION: YES/NO

17. Would you award another contract to this contractor? If not, explain in “remarks”.

SUPPORTING INFORMATION: YES/NO

Remarks_____________________________________________________________________________

[click and pick the date]

Respondent’s Signature Date

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: denina.solomon@us.af.mil Joshua.vasquez.5@us.af.mil

For Official Use Only Source Selection Information IAW FAR 2.101 and FAR 3.104

FA9301-20-R-0005

Chemical Toilet and Septic Tanks Attachment 3

Past Performance Questionnaire

FOUO

16 March 2020 mailto:denina.solomon@us.af.mil mailto:Joshua.vasquez.5@us.af.mil