Attachment 4 - Past Performance Questionnaire.docx

JOINT BASE CHARLESTON PORTABLE TOILET RENTAL and SERVICE

PAST PERFORMANCE QUESTIONNAIRE AND COVER LETTER

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

SUBJECT: Request for Past Performance Evaluation TO:

You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Portable Toilet Rental and Service contract at Joint Base Charleston, SC.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact Roger “Dale” Crews at (843) 963-3568 or roger.crews@us.af.mil .

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name:

Telephone Number:

Address:

Fax Number: 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:

Contractor 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:

Name of Respondent: Title:

Address:

Telephone Number:

C. PERFORMANCE INFORMATION

Email:

Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

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

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

YES/NO

YES/NO

Remarks: