Attachment 4 Past Performance Questionnaire.docx

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

RFO FA500024R0020

Attachment 4 Past Performance Questionnaire SUBJECT: Request for Past Performance Evaluation

TO: ________________________

__________________________is currently participating as an offeror in response to the Government’s Request for Offers No. FA500024R0020 for a firm-fixed-price FY26 Integrated Solid Waste Management (Refuse) services at Joint Base Elmendorf-Richardson, Alaska.

The Government will be selecting an awardee for this requirement based on the evaluation factors listed in the solicitation. One of the key factors in the Government’s final decision is past performance. To assist the Government in its assessment of contractor past performance, we are required to identify previous projects and clients who are familiar with our past work. For the purposes of this questionnaire, past work is defined as contracts performed and/or being performing for any customer within the last three (3) years from the issuance day of the solicitation (12 August 2024).

As one of our customers for past contracting work on __________________________________, we are requesting that you complete the attached questionnaire regarding our past performance. This letter also authorizes you to discuss our past performance with the Government and to release information regarding our past performance to the Government.

Your prompt attention in completing the attached questionnaire will ensure we receive full consideration in this competition. Please return the completed form to the Government representative point of contact identified below, to arrive no later than 12:00 P.M. Alaska Daylight Time (AKDT) on Friday, 13 September 2024.

Please use the point of contact information below to email the completed questionnaire:

TSgt Zachary Braum – zachary.braum@us.af.mil Clifford Dockter – clifford.dockter@us.af.mil

Thank you for your assistance.

(Signature and title of individual having the authority to sign for and legally bind the offeror)

Attachment : Past Performance Questionnaire

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 Description of Services Performed:

G. 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):

H. 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):

I. Was this a competitively awarded contract? ☐ Yes ☐ No

J. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor

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. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/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

1. Does your refuse collection service contract service dumpsters from 275 or more locations?

2. Does your refuse collection service contract service dumpsters at least 3 times a week?

3. Does your refuse collection service contract do special events, on-call service, or unscheduled pickups?

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. The performance rating scale is defined as follows:

DEFINITION

1. How would you rate the contractor’s ability to maintain standards outlined in your Performance Work Statement?

2. How would you rate the contractor’s quality of dumpster pickup site cleanliness after the servicing of dumpsters?

3. How would you rate the contractor’s ability to handle special events, on-call service, or unscheduled pickups?

4. How would you rate the contractor’s ability to remain on schedule, meet specific response times, and scheduled time frames for completion of specific tasks while still providing quality service?

5. How would you rate the contractor’s ability to provide bear resistant containers?

6. How would rate the contractor’s overall effectiveness in managing the contract including environmental, safety, health, and security requirements?

7. How would you rate the contractor’s ability to effectively manage their personnel?

8. Would you hire this contractor again? If not, please explain.

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

TSgt Zachary Braum – zachary.braum@us.af.mil Clifford Dockter – clifford.dockter@us.af.mil

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