Attachment 4 - Past Performance Questionnaire.pdf

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Attached to
DFAC Attendant Services
Solicitation number
W50S6S22Q0015
Issued by

About this file

This document includes a past performance evaluation questionnaire and details of a federal contract opportunity for dining facility attendant services. The opportunity is a 100% small business set-aside with a NAICS code of 722310 and size standard of $41.5 million. The solicitation number is W50S6S22Q0015 and is being issued by the Department of the Army Arizona Army National Guard as a Request for Quote with responses due by the date and time listed in SAM.gov. Vendors must include a completed SF1449 form, Section 889 representation, past performance references, and technical and capability statements with their quote, which expires on the date listed. Questions are due by May 20th and responses will be provided by amendment by May 24th. The past performance questionnaire is to be completed by references for a vendor's past contracts and addresses criteria including regulatory compliance, quality, timeliness, issue resolution, flexibility, and relationship management.

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Text version

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

SECTION A: Contractor Information

A. Contractor’s name and address: __ _________________________________________

B. Point of Contact: _____________________________

C. Phone Number (with area code): _________ __________

D. Contract number: ________________________________________

E. Project Title or Description of Work performed under this project: ___ _______________________________

F. ContractType:
Firm‐Fixed‐PriceIndefinite‐Delivery/IndefiniteQuantityTaskOrderCost‐Reimbursement

G. Contract Award Date: Scheduled Completion Date: _____________________________

H. Contract Award Amount: Current/Final Project Amount: ____________________

I. Contractorbeingevaluatedperformedasthe:
PrimeContractorSubcontractorSupplieronthiscontract/order.

SECTION B: RESPONDENT INFORMATION

EVALUATED BY:

(Signature) (Date)

_________________________________ Organization:____________________________________
(TypedorPrintedName)

______________________ Address: _______________________________ (Title)

(EmailAddress)
PhoneNumber:_______________________________

NOTE: The identity of individual(s) providing the reference information shall not be disclosed.

Source Selection Sensitive

PERFORMANCERATINGQUESTIONNAIRE
(Contractortoforwardtotheirreferencesforcompletion)
(ThisQuestionnaire,whencompleted,shallbetreatedasSourceSelectionSensitiveinaccordance
withFAR3.104‐3andshallnotbedisclosedtoanyoneoutsidetheGovernment)
TheRATINGdefinitionsareasfollows:
EEXCEPTIONAL–Performancemet/meetscontractualrequirementsandexceeded/exceedmany
requirementstotheorganization’sbenefit.Nocontractualperformanceproblemsfortheelementbeing
assessedhaveoccurredorifanyminorproblemsoccurredthecorrectiveactionstakenbythecontractor
werehighlyeffective.
VVERYGOOD–Performancemet/meetscontractualrequirementsandexceeded/exceedssome
requirementstotheorganization’sbenefit.Thecontractualperformanceoftheelementbeingassessedwas
accomplishedwithsomeminorproblemsforwhichcorrectiveactionstakenbythecontractorwereeffective.
SSATISFACTORY–Performancemet/meetscontractualrequirements.Thecontractualperformanceof
theelementbeingassessedwasaccomplishedwithsomeminorproblemsforwhichcorrectiveactionstaken
bythecontractorweresatisfactory.
MMARGINAL–Performancedidnot/doesnotmeetsomecontractualrequirements.Thecontractual
performanceoftheelementbeingassessedreflectsaseriousproblemforwhichthecontractorhasnotyet
identifiedcorrectiveactions,orthecontractor’sproposedactionsappearonlymarginallyeffective,orwere
notfullyimplemented.
UUNSATISFACTORY–Performancedidnot/doesnotmeetmostcontractualrequirementsandrecovery
isnotlikelyinatimelymanner.Thecontractualperformanceoftheelementbeingassessedcontainsserious
problem(s)forwhichthecontractor’scorrectiveactionswereineffectiveorwerenotimplementedtimely.

N NOT APPLICABLE – Unable to provide a score. Performance in this area not applicable.

PERFORMANCERATINGQUESTIONNAIRE
(Contractortoforwardtotheirreferencesforcompletion)
(ThisQuestionnaire,whencompleted,shallbetreatedasSourceSelectionSensitiveinaccordance
withFAR3.104‐3andshallnotbedisclosedtoanyoneoutsidetheGovernment)

The contractor:

1 How efficient was the contractor in abiding by all Rules, Regulations, Laws, and Safety Standards?

2 Were you satisfied with the quality of service performed or items supplied?

3 How effective were the contractor’s quality control and/or inspection procedures?

4 How well did the contractor perform in a respect to timeliness and schedule?

5 How well did the contractor resolve Issues/

Problems/Customer Complaints?

6 How flexible, cooperative, reasonable was the contractor, particularly when faced with short‐notice mission changes or requirements changes?

7 How well was the contractorabletomaintaina
good relationship withagencycontractingand
technical/projectmanagementpersonnel?

8 How likely are you to award another contract to this contractor?

9 Wasthecontractoreverissuedacure or show cause
noticeunderthereferencedcontract?Ifyesexplain
outcomein‘remarks’ sectionbelow.

ADDITIONAL REMARKS:

**Please forward this questionnaire directly to the 162D Wing Contracting Office **

E‐MAIL:

162MSC.162MSC.Contracting@us.af.mil Subject: W50S6S22Q0015 PPQ

1250948111N Highlight

Text8: Vendor being evaluated
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Check Box25: Off
Text26: Individual evaluating vendor above
Text27:
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Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Text7:
Dropdown1: [Satisfactory]
Dropdown3: [Satisfactory]
Dropdown4: [Satisfactory]
Dropdown5: [Satisfactory]
Dropdown6: [Not Applicable]
Dropdown7: [Satisfactory]
Dropdown8: [Satisfactory]
Dropdown9: [Somewhat Likely]
Dropdown10: [No]

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