Attch 5_PPQ.docx

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

Section E 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 Program Description:

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

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date through .

Current Schedule (assuming all options exercised):

Beginning Date through .

2. Reason for difference (if applicable):

I. Please provide the following information regarding cost/price:

J. Description of work performed:

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

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands): Local

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

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

F. Other suggested points of contact:

Section 4: Performance Information

In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under 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.

A. Please provide the following information with regards to complexity:

COMPLEXITY

Number of elevators serviced annually:

Does significant geographical areas exist between elevators (>50 miles):

Number of emergency calls placed to be cured within 24 hours:

REMARKS:

B. Utilizing the performance rating scale above, please complete the following with regards to overall fill, on-time fill, and turnover.

OVERALL FILL

Provided qualified employees IAW the terms and conditions of the contract.

Ensured that qualified employees remained filled IAW the terms and conditions of the contract.

Recruited, placed and retained qualified employees with minimal disruption for remote locations.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements.

TURNOVER

Retained qualified employees without frequent turnover and minimal operations disruption IAW the terms of the contract.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements.

PERFORMANCE

Complied with its quality control plan when issues arose.

Complied with all local, state, and federal regulations.

Accomplished preventative maintenance.

Accomplished annual, three, and five year inspections.

Submitted all required reports and the quality of the reports.

If other than “Satisfactory,” explain how the performance exceeds or does not meet contractual requirements.

C. GENERAL COMMENT (Choose one of the following and explain your choice in the remarks)

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I [ click and select an item ] award to him today given that I had a choice.

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:

341 CONS/PKB

7015 Goddard Drive, Bldg. 145 Malmstrom AFB, MT 59402

E-Mail to: jayce.blood@us.af.mil For Official Use Only Page 1 of 4