Attachment 5 Past Performance Questionnaire.pdf

Attachment 5: Past Performance Questionnaire

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The 94th Contracting Flight, 94th Airlift Wing Dobbins Air Reserve Base (ARB), Georgia of the Air Force Reserve Command (AFRC) is in the process of competitively selecting a source for a Medical Surveillance Services contract (hereinafter referred to as the “proposed effort”). The proposed effort requires the Contractor to provide all personnel, supervision, equipment, tools, materials, supplies, test equipment, and other items and services necessary to accomplish at Dobbins ARB, Georgia. One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to patrina.sheffield@us.af.mil and bass.brittney@us.af.mil on or before proposal due date, 6 May 2025. Your completed questionnaire will become a part of the official Source Selection records.

Your assistance is greatly appreciated, and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Program Title:

E. Brief Program Description:

F. Period of Performance:

G. Contract Dollar Value:

H. Description of work performed:

I. Was this a competitively awarded contract? Yes No

J. Contractor’s Role: Prime Contractor Subcontractor Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

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C. Geographic description of services 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 number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Other suggested points of contact:

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Section 4: Performance Information

In the tables below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. The performance rating scale is defined as follows:

CODE PERFORMANCE RATING

E

EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

U

UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Technical Performance

Item # Question E S U N/A

T1.

How effectively did the contractor provide medical surveillances?

T2.

Was medical documentation and invoices provided within agreed timelines of exam completion?

T3.

Were medical facilities kept in clean/sanitized order?

T4.

How well did the contractor provide qualified, certified, and licensed personnel to meet contract requirements throughout the life of the contract?

T5.

How easy was it to get in contact with the contractor when issues arose?

T7.

If problems were encountered during the performance of the work, describe actions taken to isolate the root causes of problems and resolve those causes.

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Technical Support Information:

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Program Management

Item # Question E S U N/A

P1.

How effective was overall contract management?

P2

How reasonable and cooperative was the contractor when dealing with program staff (including the ability to successfully resolve disagreements/disputes)?

P3.

How timely and effectively did the contractor resolve contract problems without extensive customer guidance?

P4.

How well did the contractor understand/comply with customer objectives and technical requirements?

Program Management Supporting Information below to complete and include in response packet.

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Employee Retention

Item # Question E S U N/A

E1.

How effectively was the contractor able to hire/employ key personnel, qualified, certified and/or licensed workforce to this effort?

E2.

How effectively was the contractor able to retain a qualified workforce on this effort?

Employee Retention Supporting Information.

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SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what they promised in their proposal, I award to today given if I had a choice.

Definitely Would Probably Would Might or Might

Not Probably would

Not Definitely Would

Not

REMARKS:

Please provide any additional comments concerning this contractor’s performance, as desired.

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Brittney Bass, brittney.bass@us.af.mil Patrina Sheffield, patrina.sheffield@us.af.mil

1065223550C Text Box