Attachment X - Past Performance Questionnaire.pdf

Solicitation: FA483026R0002Source Selection Sensitive Information IAW RFO 2.101 and RFO 3.104 Title: CONTRACTOR OPERATED CIVIL ENGINEER

SUPPLY STORE (COCESS)

Attachment X

Past and Present Performance Questionnaire November 2025

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for the COCESS contract at Moody AFB, GA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at

Please submit the completed questionnaire to the Government Contract Officer identified on the attached questionnaire.

Contractor Signature

Source Selection Sensitive Information IAW RFO 2.101 and RFO 3.104 Solicitation: FA483026R0002 Title: CONTRACTOR OPERATED CIVIL ENGINEER SUPPLY STORE (COCESS)

I. GENERAL INFORMATION:

To Be Completed by the Contractor

A. Offeror Information:

Name (Company/Division):

CAGE Code: UEI Number:

If Other than the Prime Offeror, Identify Prime Offeror:

B. Program Title:

C. Contract Specifics:

Contracting Agency or Customer:

Contract Number:

Contract Type:

Firm Fixed Price (FFP) Contract FFP Task Order or Purchase Order, Cost Reimbursable or Other Contractual Arrangement

Period of Performance (include options):

Contract Dollar Value:

Has the contract been entered into the Contractor Performance Assessment Reporting System (CPARS)?

Yes or No

Contract Environment:

Performance on an Air Force or Air Reserve Base Performance on a DoD Installation Performance at a Federal, State, County or City facility Other Performance Location

D. Description of Contract as Prime or Subcontractor Indicate the type of services provided and highlight portions considered most relevant to the COCESS acquisition.

E. Technician Experience: Years

Title: CONTRACTOR OPERATED CIVIL ENGINEER SUPPLY STORE (COCESS)

II. RESPONDENT INFORMATION:

To Be Completed by the Respondent

A. Contact Information Name of Respondent: Title:

Address:

Telephone Number:

Fax Number:

Email Address:

B. Is the information provided by the Contractor in Section I, General Information accurate? Yes No If not explain which information is not accurate (use separate page if needed):

C. SEND COMPLETED SURVEY FORM TO EMAIL ADDRESSES BELOW:

Contracting Officer: Mary Twitty, mary.twitty.1@us.af.mil Contract Specialist: Samuel Garfunkel, samuel.garfunkel.1@us.af.mil mailto:amanda.richardson.13@us.af.mil

Title: CONTRACTOR OPERATED CIVIL ENGINEER SUPPLY STORE (COCESS)

III. PERFORMANCE INFORMATION:

To Be Completed by the Respondent

Choose the appropriate letter on the scale (E, G, S, M, U, N) that most accurately describes the Contractor’s performance or situation or N/A if performance in this area is not applicable to the effort addressed.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements and exceeded many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the Contractor were highly effective.

Performance meets contractual requirements and exceeded some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the Contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element 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.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

Title: CONTRACTOR OPERATED CIVIL ENGINEER SUPPLY STORE (COCESS)

CONTRACTOR’S NAME: CONTRACT #:

Place an “X” in the appropriate column using the definitions matrix above.

Contractor Performance or Situation E G S M U N N/A

1. How well did the Contractor implement an orderly transition from the incumbent Contractor?

2. How well did the Contractor comply with contractual terms and conditions including the preparation and timely/accurate submission of any required documents?

3. How well did the Contractor attract and retain qualified and fully trained personnel at all levels within their organization to ensure contract compliance?

4. How well did the Contractor manage personnel clearances in order to regularly service secured locations?

5. How well does the Contractor’s organization provide the necessary manning, training, equipment, and supplies to meet contractual requirements?

6. How would you rate the Contractor’s technician skills/ expertise, knowledge, and qualifications?

7. Rate Contractor’s ability to respond to emergencies.

8. How willing was the Contractor to improve and correct noncompliance issues or concerns?

9. How well did the Contractor comply with all Federal, State, EPA, OSHA and local regulatory requirements?

10. How well did the Contractor handle, remove, document, and properly dispose of hazardous /non-hazardous wastes.

11. How well did the Contractor meet any special performance requirements, if applicable? If the Contractor did not perform any special requirements, rate as N/A.

12. How would you rate the overall performance of the Contractor under this contract?

13. Was the Contractor ever issued a default, cure or show cause notice, Notice of Violation under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

14. Would you award another contract to this Contractor? If not, explain in “remarks.” YES/NO

15. If a Government Contract, is the Contractor rated in CPARS? YES/NO

Title: CONTRACTOR OPERATED CIVIL ENGINEER SUPPLY STORE (COCESS)

Remarks (provide detail regarding unfavorable ratings):