Past_Performance_Questionnaire.pdf

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 311TH HUMAN SYSTEMS WING (AFMC)

BROOKS CITY- BASE, TEXAS

MEMORANDUM FOR PROSPECTIVE EVALUATORS

FROM: 311 HSW/PKAH

2513 Kennedy Circle, Bldg 180 Brooks City-Base, TX 78235-5115

SUBJECT: Solicitation No. F1J5AF8106A001, Hyperbaric Chamber Operator Support Services Past Performance Questionnaire

The United States Air Force School of Aerospace Medicine is in the process of selecting a contractor for Hyperbaric Chamber Operator Support Services for the Hyperbaric Medicine Division, at Brooks City- Base, Texas. The contractor will provide the services required in accordance with the Performance Work Statement entitiled “Hyperbaric Chamber Operator”.

One of the considerations in proposal evaluation is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had first-hand experience with an offeror, for the evaluation of the offeror's performance on those contracts.

Our areas of interest in the offeror are summarized in the enclosed questionnaire. Our schedule is extremely tight; therefore, please provide us with your written response no later than 18 September 2008.

This schedule will allow sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and "faxed" to 210-536-6316 (Attention: Phillip Waters). Please call Phillip Waters at 210-536- 5977 to transmission or if you have any questions. Your completed questionnaire will become a part of the official Source Selection records.

Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

[signed] Ralph Urias

Contracting Officer

Attachment:

Past Performance Questionnaire

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Company Name / Division:__________________________________________________________

B. Product/Service: __________________________________________________________________

C. Contracting Agency / Customer_______________________________________________________

D. Contract number: _______________________________________

D. Contract Period of Performance: From___________________To _________________

E. Initial contract cost: $____________________________

F. Current/final contract cost: $_______________________________

G. Reasons for differences between initial contract cost and final contract costs:

H. Description of service provided:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

D. Number of years evaluator worked on subject contract: ____________________________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

A B C D E N/A Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded 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 with some exceeded 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.

The questions shown below should be tailored to the Factors/Subfactors of the instant acquisition.

Program Management A B C D E N/A

Provide experienced hyperbaric chamber operator with the technical and administrative abilities needed to meet contract requirements.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Corrected deficiencies in timely manner and pursuant to their quality control procedures.

Provide timely resolution of contract discrepancies

Suggested alternative approaches to problems.

Displayed initiative to solve problems.

Was responsive to contract changes.

Cooperated with Government personnel after award.

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Program Management A B C D E N/A

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

Understand/complied with customer objectives and technical requirements

Successfully responded to emergency situations

Effectiveness of material management (including Government Furnished Property or Material)

Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Ability to hire/apply a qualified workforce to this effort.

Ability to retain a qualified workforce on this effort.

2. Please discuss each and every response for which you indicated A (Exceptional), D (Marginal) or E (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Email Address: Gregorio.Armand@Brooks.af.mil

Or FAX to: 210-536-3380