Attachment 8 - Past Performance Questionnaire.pdf

FA524026Q0021 – Aircraft Hangar Fall Arrest System Maintenance, Certification & Repair Services Attachment 8 – Past Performance Questionnaire

Controlled Unclassified Information (CUI) When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Controlled Unclassified Information (CUI) Page 1 of 4

SUBJECT: Request for Past Performance Evaluation

TO: ________________________

__________________________is currently participating as a respondent to the Government’s Request for Quotation No. FA524026Q0021 – Aircraft Hangar Fall Arrest System Maintenance, Certification & Repair Services at Andersen Air Force Base, Guam. For which we anticipate awarding a purchase order.

The Government will be selecting Contractors for this project based on selection factors. One of the key factors in the Government’s final decision is past performance. To assist the Government in its assessment of Contractor past performance, we are required to identify previous projects and clients who are familiar with our past work. For the purposes of this questionnaire, past work is defined as contracts performed and/or being performing for any customer within the last three (3) years from the issuance day of the solicitation.

As one of our customers for past contracting work on __________________________________, we are requesting that you complete the attached questionnaire regarding our past performance. This letter also authorizes you to discuss our past performance with the Government and to release information regarding our past performance to the Government.

Your prompt attention in completing the attached questionnaire will ensure we receive full consideration in this competition. Please return the completed form to the Government point of contacts (POCs) identified below, response is required no later than 17th August 2026 at 12:00 P.M. Chamorro Standard Time (ChST).

Government POCs Nicole Servin – nicole.servin@us.af.mil Nathaniel Entilla – nathaniel.entilla@us.af.mil

Thank you for your assistance and time.

(Signature and title of individual with the authority to sign for and legally bind the Contractor)

Attachment : Past Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836 mailto:nicole.servin@us.af.mil mailto:nathaniel.entilla@us.af.mil

Controlled Unclassified Information (CUI) Page 2 of 4

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor CAGE Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Description of Services Performed:

G. Period of Performance:

H. Contract Dollar Value:

I. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

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

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

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Section 4: Performance Information

Scope of Work Yes No

1. "Does your contract include the scheduled preventative maintenance and semi-annual inspections of aircraft hangar fall protection systems or similarly complex systems?

2. Does your contract include annual certification and the execution of a Five- Year Engineering and Design Review (EDR) conducted and stamped by a licensed Professional Engineer (PE)

3. Does your contract include the repair of fall arrest components (e.g., horizontal lifelines, self-retracting devices)

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

RATING DEFINITION

E Excellent Performance meets all contractual requirements and exceeds many, if not all, aspects of performance. 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 Unacceptable 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.

Contractor Performance: E S U N/A

1. How would you rate the Contractor’s ability to maintain standards outlined in your Performance Work Statement, Statement of Work, or equivalent requirements documents?

2. How would you rate the contractor’s ability to proactively respond, recognize, and resolve unanticipated difficulties, correct deficiencies, re‐performance, or emergencies in the manner consistent with the contract’s quality control procedure?

3. How well did the contractor provide for sufficient and qualified manpower in the performance of this contract?

Controlled Unclassified Information (CUI) Page 4 of 4

Contractor Performance: E S U N/A

4. How would you rate the contractor’s ability to remain on schedule, meet specific response times, and scheduled time frames for completion of specific tasks while still providing quality service?

5. How would you rate the Contractor’s customer service?

6. Would you hire this Contractor again? If not, please explain.

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Nicole Servin – nicole.servin@us.af.mil

Nathaniel Entilla – nathaniel.entilla@us.af.mil mailto:nicole.servin@us.af.mil mailto:nathaniel.entilla@us.af.mil