Attachment 4 - Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

AST/UST Maintenance Services McConnell AFB Kansas

FA4621-25-Q-0015

PAST PERFORMANCE QUESTIONNAIRE AND COVER LETTER

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive in accordance with Federal Acquisition Regulation (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 the Aboveground / Underground (AST/UST) Maintenance Service contract at McConnell

AFB, KS.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact Mrs. Lindsay Manning at commercial phone: 316-759-5659; email: lindsay.manning.1@us.af.mil or SSgt Jacob Sandy at commercial phone: 316-759-2297; email: jacob.sandy@us.af.mil.

CAMERON D. COLLINS, CIV, GS-12

Contracting Officer

Attachment:

1. Past and Present Performance Questionnaire mailto:mohammad.eftekhari@us.af.mil mailto:jacob.sandy@us.af.mil

FA4621-25-Q-0015

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

Contractor’s Name:

Address:

Telephone Number: Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Number: Dollar Amount: per

Contract Period or Dates of Performance Provided by Offeror:

*Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

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

B. RESPONDENT INFORMATION:

Name of Respondent:

Title:

Address:

Telephone Number: Fax Number:

Email Address:

C. EMAIL COMPLETED SURVEY FORM TO THE GOVERNMENT:

Send copies of completed surveys directly to the Government at the following email addresses:

lindsay.manning.1@us.af.mil jacob.sandy@us.af.mil mailto:jennifer.marrs.3@us.af.mil mailto:mohammad.eftekhari@us.af.mil

FA4621-25-Q-0015

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets/met contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets/met contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets/met contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet/did not meet some contractual requirements.

The contractual performance of the element or sub-element 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.

Performance does not meet/did not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: CONTRACT N0.

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

The contractor: E G S M UC

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

2. Home office participated in solving significant local problems.

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

4. Complied with all federal, state and local laws and regulations to include appropriate licensing.

5. Complied with all USAF regulations.

6. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

7. Identified problems as they occurred.

8. Suggested alternative approaches to problems.

9. Displayed initiative to solve problems.

10. Met established contract schedules.

11. Was responsive to contract changes.

12. Provided adequate project supervision.

13. Cooperated with Government personnel after award.

14. How would you rate the contractor's overall performance?

15. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” YES/NO

16. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

17. Is this contract rated in CPARS? YES/NO

Remarks:

Signature of Reviewer Date