Attachment 5 - Past Performance Questionnaire.pdf

FA485524R0007

Attachment 5

PAST PERFORMANCE QUESTIONNAIRE

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

MEMORANDUM FOR VENDORS

SUBJECT: Request for Past Performance Information

FROM: 27 SOCONS/PKA

110 E. Alison Ave, Bldg. 600 Cannon AFB NM 88103

1. You have been identified as a point of contact for a past and/or present performance evaluation of the firm identified on the attached questionnaire. This firm is currently interested in providing Integrated Solid Waste Management (ISWM) services for Cannon Air Force Base, Request for Proposal FA485524R0007.

2. As part of the government’s evaluation of offers to this requirement, recent and relevant past performance will be evaluated for offerors who performed ISWM services. ISWM is defined as a combination of municipal solid waste collection and recycling services. Municipal waste is considered all refuse and household garbage collection and processing.

3. Please complete the attached survey questionnaire and email the survey to ingrid.woolfolk@us.af.mil and patricia.thatcher@us.af.mil.

4. Your contribution and prompt attention to this questionnaire is greatly appreciated. To be considered timely, responses MUST be received no later than 10:00 AM MDT on 22 May 2024 with proposal. If you have any questions concerning this request, please contact the contract specialist at ingrid.woolfolk@us.af.mil or

575-784-6193 (DSN 681-6193).

//SIGNED//

PATRICIA L. THATCHER, GS-12 DAF

Contracting Officer

1 Attachment Past Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/af_afmc/far/Far02.doc#T2101 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/af_afmc/far/FAR03.DOC#b3104

SOURCE SELECTION SENSITIVE (When completed) IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor's Name: Telephone No.:

Business Address: Fax No.:

Point of Contact:

E-mail Address:

Contract Number: Contract Value:

Contract Period or Dates of Performance Provided: __________________________________

Project Title and Brief Description of Relevant Work: _________________________________

Location(s) of Performance: _____________________________________________________

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 7 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Respondent’s Name: Title:

Address: Telephone No.:

Fax No.:

E-mail Address:

C. RETURN COMPLETED SURVEY FORM TO:

Attn: 27 SOCONS/PKA Attn: Ms. Patricia Thatcher and SSgt Ingrid Woolfolk E-mail: ingrid.woolfolk@us.af.mil and patricia.thatcher@us.af.mil.

SOURCE SELECTION SENSITIVE (When completed) IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

Table 1: Definitions of Ratings.

E VG S M U

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Performance meets contractual requirements and exceeds many to the

Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements and exceeds some to the

Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

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

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does 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.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, VG, S, M, and U) that most accurately describes the contractor’s performance or situation. Refer to Table 1: Definitions of Ratings.

Place an “X” in the appropriate column using the Table 1: Definitions of Ratings # The contractor… E VG S M U 1 How would you rate the contractor's overall Management?

Briefly describe rationale behind overall rating:

1.1 Provided experienced contractor manager with skilled experience and administrative abilities.

1.2 Demonstrated ability to hire, maintain, and replace qualified contract personnel.

1.3 Provided adequate supervision and personnel assignments.

1.4 Effective coordination and communication with customer(s).

1.5 Identified problems as they occurred.

1.6 Suggested alternative approaches to problems.

1.7 Displayed initiative to solve problems.

SOURCE SELECTION SENSITIVE (When completed) IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

# The contractor… E VG S M U 2 How would you rate the contractor's overall Performance?

Briefly describe rationale behind overall rating:

2.1 Ensured necessary equipment was properly maintained and fully operational to meet all Performance Work Statement standards.

2.2 Ensured replacement equipment was provided with little or no disruption to services.

# The contractor… E VG S M U 3 How would you rate the contractor's overall Quality of Service?

Briefly describe rationale behind overall rating:

3.1 Provided effective quality control and inspection procedure to meet requirements.

3.2 Followed approved quality control plan.

3.3 Properly completed and submitted necessary documentation.

SOURCE SELECTION SENSITIVE (When completed) IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

# The contractor… E VG S M U 4 How would you rate the contractor's overall Schedule of Service and

Equipment Maintenance?

Briefly describe rationale behind overall rating:

4.1 Timely completion of work orders/delivery schedules.

4.2 Timely submission of monthly reports.

4.3 Ensured necessary equipment was properly maintained and fully operational to meet all PWS standards.

4.4 Ensured replacement equipment was provided with little or no disruption to services.

# The contractor… E VG S M U 5 How would you rate the contractor's overall Business Relations?

Briefly describe rationale behind overall rating:

5.1 Delegated authority to contract manager

5.2 Home office participated in solving significant local problems.

5.3 Cooperated with Government personnel after award.

5.4 Paid employees/subcontractors in a timely manner.

6 Was the contractor ever issued a cure or show cause notice under the referenced contract?

Y N If Yes, explain below

SOURCE SELECTION SENSITIVE (When completed) IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

7 Would you award another contract to this contractor? Y N If No, explain below

8 Is the contractor rated in CPARS? Y N

Additional comments by Item No.: (PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U).