Attachment 5 - PPIF.pdf
PDF 105 KB Posted
- Solicitation number
- FA4528-23-Q-BM03
About this file
This document is a past performance information form for a contractor seeking to provide vertical transportation equipment maintenance, repair, and inspection services at Minot Air Force Base in North Dakota. The services include maintaining, repairing, and inspecting all real property vertical transportation equipment such as freight and passenger elevators, wheelchair/stair lifts, dock levelers, and dumbwaiters. The contract will have a period of performance of five years. References are requested to evaluate the contractor's ability to hire and retain qualified personnel, rate the contractor's past performance, and determine if the reference would award another contract to the contractor. The completed form must be returned no later than the offer due date in the solicitation, which can be obtained from the contractor's VTE representative.
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FA4528-23-Q-BM03
Attachment 5 Page 1 of
PAST PERFORMANCE INFORMATION FORM
The 5th Contracting Squadron, Minot AFB, North Dakota, is in the process of selecting a contractor for Vertical Transportation Equipment (VTE) Maintenance, Repair, and Inspection Services. One of the considerations in proposal evaluation is the verification of the Offeror’s past and present performance on contracts, which reflect the Offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had first-hand experience with an Offeror, for the evaluation of the Offeror's performance on those contracts.
Please complete this form and provide comments wherever applicable. Please sign the document in the space provided. Please note, we may contact the Offeror on problem areas or concerns identified to see what corrective actions have been taken or will be taken. However, the individual's name completing the questionnaire will not be disclosed to the Offeror.
Please return the completed form as soon as possible but no later than the offer due date noted in the Solicitation.
Please obtain this date from your VTE contractor. The completed document should be marked Source Selection Sensitive. Forms submitted directly from the Contractor being evaluated will be thrown out.
Respondent and Contract Information:
Name of Customer/Contract:
Address:
Name and Title of Evaluator:
Signature of Evaluator and Date:
Telephone No:
Dates/Years of Performance:
Annual $ Value:
Contract Number:
Contractor Name & Address:
Contractor performed as the Prime Contractor Sub-Contractor
Services Performed/Detailed Description of Work:
Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary, qualified personnel?
FA4528-23-Q-BM03
Attachment 5 Page 2 of
How would you rate the contractor’s past performance?
Would you award another contract to this contractor? If not, please explain:
Was the contractor ever issued a cure or show cause notice, or was the contract terminated? If yes, please explain:
Is the contract rated in CPARS? Yes No
Remarks:
SEND COMPLETED SURVEY FORM TO:
5 CONS/PKAS, 165 Missile Ave., Minot AFB, ND 58705 ATTN: Scott Stauffer FAX: (701) 723-4172 EMAIL: scott.stauffer@us.af.mil
DUTY PHONE: (701) 723-7499
mailto:scott.stauffer@us.af.mil
| PAST PERFORMANCE INFORMATION FORM |
| Respondent and Contract Information: |
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