Attachment 3 - Past Performance Questionnaire.docx

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past Performance Evaluation

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a construction contract at Edwards AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact Jonny Ochoa at (661) 277-0968 or jonny.ochoa@us.af.mil.

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

KIM M DAVIS

Contracting Officer

1 Atch Past and Present Performance Questionnaire

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: Address: Phone Number:

Project Title and Brief Description of Work:

Contract Number Provided by Offeror:

Dollar Amount:

Contract Period or Dates of Performance Provided by Offeror:

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address:

Telephone Number: Fax Number: Email Address:

Respondent wet or digital signature: _________________________

C. EMAIL COMPLETED SURVEY FORM TO: AFTC/PCIOZ Contracting Attn: Jonny Ochoa jonny.ochoa@us.af.mil

D. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (1, 2, 3, 4, and 5) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 4 or 5.

Place an “X” in the appropriate column using the definitions matrix above.

18. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain.

EXPLANATION:

· Yes

· No

· No