Attachment 4- Past Performance Questionnaire.docx

CONTRACTOR NAME: CONTRACT NUMBER:

Attachment 5 Past Performance Questionnaire For use in acquiring classroom drone packages and curriculum for the Air Force Junior Reserve Officer Training Corps (AFJROTC) by the contracting office at Maxwell AFB, AL. E-MAIL OR FAX COMPLETED SURVEY FORM TO: William M. Griffiths at william.griffiths.5@us.af.mil and Sandra K. Turner at sandra.turner.1@us.af.mil or fax number (334) 953-3543. Please include the contractor name and contract number at the top of each page to avoid confusion of ratings between contractors and projects.

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

Contractor’s Information

Point of Contact:

Project Title and Brief Description of Work:

Contract Number Provided by Offeror: Dollar Amount: Contract Period or Dates of Performance Provided by Offeror: Contract performed as the Prime Contractor Sub – Contractor Key Personnel

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Respondent’s Information

Fax Number:

Email Address:

C. PERFORMANCE INFORMATION: Choose the appropriate letter from the table (A or U) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATING OR “U.”

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

Was the contract partially or completely terminated for default? Yes No Explain:

Was the contractor ever issued a cure or show cause notice? Yes No Explain:

Remarks:

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