Attachment No. 3 - Past Performance Questionnaire - FA441821Q0014.pdf

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Section L Attachment: Past Performance Questionnaire

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The 628th Contracting Squadron, Joint Base Charleston (JB CHS), is in the process of competitively selecting a source for Operation and Maintenance of Small Boat and Outboard Engine Maintenance and Repair Services at JB CHS – Weapons Station.

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. In order to meet the acquisition milestones, we request your written response no later than 02 Aug 2021.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed or by hand and faxed to the Point of Contact(s) identified below. Your completed questionnaire will become a part of the official records.

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

ATTN : Mr. Terry Harrleson, Contracting Officer Email : terry.harrelson.1@us.af.mil Phone : (843) 963-5158

ATTN : Ms. Taylor Keefer, Contract Specialist Email : taylor.keefer@us.af.mil Phone : (843) 963-4491

Contracting Officer 628 CONS/PKA / Terry G. Harrelson Ph: (843) 963-5158 terry.harrelson.1@us.af.mil 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:terry.harrelson.1@us.af.mil mailto:taylor.keefer@us.af.mil

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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. Contract Title:

F. Brief Description of Work Performed:

G. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

H. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

I. Was this a competitively awarded contract? ☐ Yes ☐ No

K. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic Location(s)):

Section 3: Respondent Identification

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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

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. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. 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.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the

Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were 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.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

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.

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The Contractor: E V S M U N/A

1. Demonstrated the ability to hire, maintain, and replace, qualified personnel.

SUPPORTING INFORMATION:

2. Home office participated in solving significant local problems.

3. Provided effective quality control and/or inspection procedures to meet contract requirements.

4. Corrected deficiencies in timely manner utilizing their quality control plan.

5. Provided timely resolution of contract discrepancies.

6. Identified problems as they occurred.

7. Suggested alternative approaches to problems.

8. Displayed initiative to solve problems.

9. Performed Work Orders and provided accurate and complete price proposals .

10. Cooperated with Government personnel after award.

11. How would you rate the contractor's overall performance on this contract?

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The Contractor: E V S M U N/A

12. Was the contractor issued a cure or show cause notice under the referenced contract?

If yes, explain.

EXPLANATION:

☐ Yes

☐ No

13. Would you award another contract to this contractor?

If not, explain.

EXPLANATION:

☐ Yes

☐ No

Additional remarks:

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: E-Mail to:

101 E. Hill Blvd, Bldg. 503 terry.harrelson.1@us.af.mil Joint Base Charleston, SC 29404-5021 taylor.keefer@us.af.mil 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:terry.harrelson.1@us.af.mil mailto:taylor.keefer@us.af.mil