Attachment 9_Past Performance Questionnaire.docx

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

RFQ FA5000-22-Q-0013

Attachment 9 Past Performance Questionnaire SUBJECT: Request for past Performance Evaluation

TO: ________________________

__________________________is currently participating as a quoter in response to the Government’s Request for Quotation No. FA5000-22-Q-0013 for a firm-fixed-price change of occupancy maintenance services at Joint Base Elmendorf-Richardson, Alaska.

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 five (5) years from the issuance day of the solicitation (25 March 2022).

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 representative point of contact identified below, to arrive no later than 12:00 P.M. Alaska Standard Time (AKST) on Friday, April 22nd, 2022.

Please use the point of contact information below to email the completed questionnaire:

Stephen Hulsey – Stephen.hulsey@us.af.mil Kenneth Gunn – Kenneth.gunn@us.af.mil

Thank you for your assistance.

(Signature and title of individual having the authority to sign for and legally bind the quoter)

Attachment : Past Performance Questionnaire

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:

Section 4: Performance Information

1. Does your contract involve cleaning an average of 170 rooms or more a month?

2. Does your contract involve carpet cleaning an average of 85 rooms or more a month?

3. Does your contract involve an average of 25,132 square feet or more of interior painting a month?

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:

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 quality of the contractor’s interior painting?

3. How would you rate the contractor’s ability to complete and return units in the time allotted?

4. How would you rate the contractor’s ability to effectively manage their personnel?

5. Would you hire this contractor again? If not, please explain.

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Stephen Hulsey – Stephen.hulsey@us.af.mil Kenneth Gunn – Kenneth.gunn@us.af.mil Controlled Unclassified Information (CUI) Page 4 of 4