Attachment 3- Past Performance Questionnaire blank.pdf
PDF 451 KB Posted
- Attached to
- Airfield Sunshade Fabric Replacement Federal contract opportunity
- Solicitation number
- W50S6S20R0004
About this file
This solicitation seeks proposals for the replacement of airfield sunshade fabric at an Arizona Army National Guard facility. The requirement is set aside 100% for small businesses with a NAICS code of 332311 and size standard of 750 employees. Interested vendors may request a site visit by June 8th and must submit any questions by June 11th. Proposals are due by the date specified in beta.sam.gov and must be sent to the listed email address, including a completed SF1449. The federal agency involved is the Department of the Army Arizona Army National Guard.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SF30 W50S6S20R0004 - Amendment 0003.docx | DOCX document | |
| Reference Photos.pptx | PPTX presentation | |
| Amended Q AND A - W50S6S20R0004.docx | DOCX document | |
| SF30 - W50S6S20R0004 - Amendment 0002.docx | DOCX document | |
| (Amended) Attachment 1 - Statement of Need .docx | DOCX document | |
| Q AND A - W50S6S20R0004.docx | DOCX document | |
| SF30 - Amendment 0001 - W50S6S20R0004.docx | DOCX document | |
| Attachment 1 - Statement of Need.docx | DOCX document | |
| SF1449 - W50S6S20R0004.docx | DOCX document | |
| Attachment 2 - Reference_List Blank.doc | DOC document |
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Text version
PAST PERFORMANCE EVALUATION QUESTIONNAIRE
SECTION A: Contractor Information
A. Contractor’s name and address: __ _________________________________________
B. Point of Contact: _____________________________
C. Phone Number (with area code): _________ __________
D. Contract number: ________________________________________
E. Project Title or Description of Work performed under this project: ___ _______________________________
| F. Contract | Type: | |||||
| Firm‐Fixed‐Price | Indefinite‐Delivery/Indefinite | Quantity | Task | Order | Cost‐Reimbursement |
G. Contract Award Date: Scheduled Completion Date: _____________________________
H. Contract Award Amount: Current/Final Project Amount: ____________________
| I. Contractor | being | evaluated | performed | as | the: | |||||
| Prime | Contractor | Subcontractor | Supplier | on | this | contract/order. |
SECTION B: RESPONDENT INFORMATION
EVALUATED BY:
(Signature) (Date)
| _________________________________ Organization: | ____________________________________ | ||
| (Typed | or | Printed | Name) |
______________________ Address: _______________________________ (Title)
| Address) | ||
| Phone | Number: | _______________________________ |
NOTE: The identity of individual(s) providing the reference information shall not be disclosed.
Source Selection Sensitive
| PERFORMANCE | RATING | QUESTIONNAIRE | |||||
| (Contractor | to | forward | to | their | references | for | completion) |
| (This | Questionnaire, | when | completed, | shall | be | treated | as | Source | Selection | Sensitive | in | accordance |
| with | FAR | 3.104‐3 | and | shall | not | be | disclosed | to | anyone | outside | the | Government) |
| The | RATING | definitions | are | as | follows: | ||||||||||
| E | EXCEPTIONAL | – | Performance | met/meets | contractual | requirements | and | exceeded/exceed | many | ||||||
| requirements | to | the | organization’s | benefit. | No | contractual | performance | problems | for | the | element | being | |||
| assessed | have | occurred | or | if | any | minor | problems | occurred | the | corrective | actions | taken | by | the | contractor |
| were | highly | effective. |
| V | VERY | GOOD | – | Performance | met/meets | contractual | requirements | and | exceeded/exceeds | some | ||||
| requirements | to | the | organization’s | benefit. | The | contractual | performance | of | the | element | being | assessed | was | |
| accomplished | with | some | minor | problems | for | which | corrective | actions | taken | by | the | contractor | were | effective. |
| S | SATISFACTORY | – | Performance | met/meets | contractual | requirements. | The | contractual | performance | of | ||||
| the | element | being | assessed | was | accomplished | with | some | minor | problems | for | which | corrective | actions | taken |
| by | the | contractor | were | satisfactory. |
| M | MARGINAL | – | Performance | did | not/does | not | meet | some | contractual | requirements. | The | contractual | ||||
| performance | of | the | element | 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 | did | not/does | not | meet | most | contractual | requirements | and | recovery | |||||
| is | not | likely | in | a | timely | manner. | The | contractual | performance | of | the | element | being | assessed | contains | serious | |
| problem(s) | for | which | the | contractor’s | corrective | actions | were | ineffective | or | were | not | implemented | timely. |
N NOT APPLICABLE – Unable to provide a score. Performance in this area not applicable.
| PERFORMANCE | RATING | QUESTIONNAIRE | |||||
| (Contractor | to | forward | to | their | references | for | completion) |
| (This | Questionnaire, | when | completed, | shall | be | treated | as | Source | Selection | Sensitive | in | accordance |
| with | FAR | 3.104‐3 | and | shall | not | be | disclosed | to | anyone | outside | the | Government) |
The contractor:
1 How efficient was the contractor in abiding by all Rules, Regulations, Laws, and Safety Standards?
2 Were you satisfied with the quality of service performed or items supplied?
3 How effective were the contractor’s quality control and/or inspection procedures?
4 How well did the contractor perform in a respect to timeliness and schedule?
5 How well did the contractor resolve Issues/
Problems/Customer Complaints?
6 How flexible, cooperative, reasonable was the contractor, particularly when faced with short‐notice mission changes or requirements changes?
| 7 How well was the contractor | able | to | maintain | a |
| good relationship with | agency | contracting | and | |
| technical/project | management | personnel? |
8 How likely are you to award another contract to this contractor?
| 9 Was | the | contractor | ever | issued | a | cure or show cause | |
| notice | under | the | referenced | contract? | If | yes | explain |
| outcome | in | ‘remarks’ section | below. |
ADDITIONAL REMARKS:
**Please forward this questionnaire directly to the 162D Wing Contracting Office **
E‐MAIL: usaf.az.162-wg.list.msg-msc@mail.mil Subject: W50S6S-20-R-0004 PPQ
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| Check Box25: Off |
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| Check Box1: Off |
| Check Box2: Off |
| Check Box3: Off |
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| Dropdown1: [Very Good] |
| Dropdown3: [Satisfactory] |
| Dropdown4: [Marginal] |
| Dropdown5: [Marginal] |
| Dropdown6: [Not Applicable] |
| Dropdown7: [Very Good] |
| Dropdown8: [Marginal] |
| Dropdown9: [Not At All Likely] |
| Dropdown10: [No] |
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