Attachment 3 - Past Performance Questionnaire.pdf

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

52.212-1 Attachment: Past Performance Questionnaire

The 509th Contracting Squadron of the Air Force Global Strike Command is in the process of competitively selecting a source for a Packing and Crating Service. The contractor will furnish all personnel, equipment, facilities, supplies, services, and materials for the preparation of personal property moves of DoD employees in and around the Whiteman Air Force Base community area.

One of the considerations in proposal evaluation is the verification of the offerors’ past performance on contracts of other work efforts which reflect the offeror’s ability to perform on the proposed effort. We depend on the 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 XX XXX XXXX. This schedule will allow us sufficient time to analyze the data prior to start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled our electronically and email to francisco.martinez_martinez.1@us.af.mil and jessica.king.6@us.af.mil. Please contact SrA Martinez Martinez at 660-687-5433 if you have any questions or concerns. Your complete 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.

Contracting Officer.

Attach.

Past Performance Questionnaire.

mailto:francisco.martinez_martinez.1@us.af.mil mailto:jessica.king.6@us.af.mil

52.212-1 Attachment: Past Performance Questionnaire

Controlled Unclassified Information

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 five (5) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Controlled Unclassified Information

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. name:

B. title:

C. phone /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.

V VERY GOOD – Performance meets contractual requirements and exceeds some 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.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains minor problems for which corrective actions taken by the contractor appear or were satisfactory.

52.212-1 Attachment: Past Performance Questionnaire

Controlled Unclassified Information

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 V S M U N/A

1. Provided experience managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Supporting Information:

2. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Supporting Information:

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

Supporting Information:

4. Home office participated in solving signification local problems.

Supporting Information:

5. Followed approved quality control plan.

Supporting Information:

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

Supporting Information:

Controlled Unclassified Information

The contractor: E V S M U N/A

7. Contractor maintained DD Form 1812, Warehouse Inspection

Report, with a passing score.

8. Contractor maintained insurance coverage with a “A” rating for the warehouse, workmen compensation, liability and automobile.

9. Contractor’s Quality Control (QC) Person had no overlapping of duties or responsibilities that conflicted with performance as QC.

10. The contractor’s quality control person demonstrated good working relationships with the Government Inspectors and the Contracting Staff

11. Contractor demonstrated adequate inspection and resolution for safety requirements.

12. How well did the contractor comply with environmental requirements?

13. How well did the contractor comply with security requirements?

52.212-1 Attachment: Past Performance Questionnaire

Controlled Unclassified Information

The contractor: E V S M U N/A

14. Provided timely resolution of contract discrepancies.

Supporting Information:

15. Met established delivery schedule.

Supporting Information:

16. Was responsive to contract changes.

Supporting Information:

17. Was responsive to emergency and/or surge situation.

Supporting Information:

18. Provided adequate project supervision.

Supporting Information:

19. Paid subcontractors/suppliers in a timely manner.

Supporting Information:

20. Provided accurate and complete line-item cost proposals including all aspects of work required for each task.

Supporting Information:

21. Cooperated with Government personnel after award.

Supporting Information:

22. Met or exceeded small business and small disadvantaged business goals set forth in the approved subcontracting plan.

Controlled Unclassified Information

The contractor: E V S M U N/A

23. How would you rate the contractor's overall performance on this contract?

24. If the contract included FAR 52.219-9, to what degree was the contractor able to meet or exceed small business and small disadvantaged business goals set forth in the approved subcontracting plan?

(Please state if FAR 52.219-9 was not included in the contract)

25. If the contract included FAR 52.219-8, how effectively did the contractor manage small business participation to meet technical performance?

(Please state if FAR 52.219-8 was not included in the contract)

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

Explanation:

Yes

No

27. Would you award another contract to this contractor? If not, explain.

Explanation:

Yes

No

Additional Remarks:

Respondent’s Signature Date