Attch_03_Past Performance Questionnaire.doc

SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104. FOR OFFICIAL USE ONLY

RFP FA8534-21-R-0004

ATTACHMENT 3

10K/50K/210K COLLAPSIBLE FUEL TANKS

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program Manager):________________________________________________________

Agency or Business: ______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Address: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________

Telephone No. _______________________________

FAX No. ____________________________________

Return your completed questionnaire electronically to amy.holder@us.af.mil and philip.holt@us.af.mil .

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE RELEASED TO THE OFFEROR.

Part I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________

CAGE Code: __________

Program Title and Brief Description: _____________________________________________________________________________________

Role in the Program/Work Performed As:

_____Prime _____Subcontractor _____Vendor/Supplier

Contract Number: ________________________________ Number of Years?: Basic:________ Option: _________

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, etc._________________________________________________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

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) ___________________________________________________________________________________

Contract Dollar Value:

1. Original MAX Contract $ Value (assuming all options exercised):________________________________________________________

2. Current MAX $ Value (assuming all options exercised): ________________________________________________________________

3. Primary Causes of Changes: ______________________________________________________________________________________

NOTE: In Part III., should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 4 of 5 or on an additional sheet to this document (which is in word format). If supporting documentation is not provided for ratings that are other than “satisfactory,” the ratings will be considered to be unsubstantiated and will be interpreted as satisfactory.

PART III. PERFORMANCE ASSESSMENTS.

Please check the appropriate rating for each of the following questions:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

1. Extent to which the company’s products and/or services met the requirements of the customer’s contract or project:

2. Company’s level of workmanship and quality in the products and services provided on the contract or project:

3. Company’s proficiency with processing the customer’s contract or project including timely initiation of work, timely deliveries of product/services, and invoices:

4. Customer’s satisfaction with the company’s response to warranty claims, corrective actions, product recalls, and/or other “after the sale” actions:

5. Company’s level of attention to detail, responsiveness to customer concerns/questions/inquiries, and promptness in submitting data

(including technical reports and/or management status reports) – during the performance of the contract:

6. Company’s knowledge and proficiency with industry specifications and standards, for example American Welding Society (AWS), American Society of Mechanical Engineers (ASME), etc.

7. Extent to which the company utilized small businesses, veteranowned small businesses, small disadvantaged businesses, and other such socio-economic business sectors in its contract performance:

8. The company performed independently its work on the contract or effort without significant customer direction/oversight:

PART IV. MISCELLANEOUS:

1. Has this company ever defaulted on any contact or portion thereof with your company? If yes, please explain the circumstances and the resolution.

(Provide additional sheets as required.) ________________________________________________________________________________________

2. Have there been any disputes or claims relative to the contract? If yes, please explain the circumstances and resolution. (Provide additional sheets as required.) _____________________________________________________________________________________________________________

3. What were the Company’s strong and/or weak characteristics. __________________________________________ ________________________________________________________________________________________________________________________

4. Given the opportunity to choose other suppliers or contractors, would you choose this Company again? If not, please explain. _________________

Evaluator Signature

Date

RFP FA8534-21-R-0004

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

ASSESSMENT RATING SYSTEM

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: Did not apply to this acquisition; or, questionnaire respondent has no knowledge of, and/or did not observe, the contractor’s performance in this area.

NOTICE TO QUESTIONNAIRE RESPONDENTS: Please do not include this page when returning the completed questionnaire.

SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104. FOR OFFICIAL USE ONLY