Atch_7_Past_Performance_Questionaire.docx

PAST PERFORMANCE QUESTIONAIRE

A. Project Information Project Number (Check one) |_|Proj 1 |_|Proj 2 |_|Proj 3 |_|Proj 4 |_|Proj 5

Project Title

Project Location

Award Date:

Completion Date:

Contract #:

Delivery Order/ Task Order:

Total $ Amount:

B. Technical Experience Included in Project

C. Details Provide a detailed description of the technical qualifications documented by this project, including scope of work performed, types of coatings and product names of materials (e.g., abrasive and applied coatings and linings), equipment used for surface preparation and coating/lining operations, type and number of personnel who supervised/performed the work, application methods, substrates, repair processes, abatement processes, and any special requirements such as safety, environmental compliance or traffic control (include square footage of each item, its relevance to the overall project, and any unique considerations).

Photographs are encouraged but not required to demonstrate technical ability.

Clearly mark which example project is supported by any accompanying documentation.

Title:

Address:

Telephone Number:

Fax Number:

Email Address:

E. Respondent Evaluation of Contractor

EMAIL COMPLETED SURVEY FORM TO: Patricia A. Bates at patricia.bates@us.af.mil, or Christina Johnsen, at christina.johnsen@us.af.mil.

PERFORMANCE INFORMATION: Choose the appropriate rating on the scale (Acceptable or Unacceptable) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY OVERALL RATING OF UNACCEPTABLE.

PERFORMANCE EVALUATION RATING: Use the following performance evaluation rating description when providing information on the matrix below:

Acceptable = Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown.

Unacceptable = Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

CONTRACTOR’S NAME: _____________________ CONTRACT NUMBER: ____________________________

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

Overall Rating:

CONTRACTOR’S NAME: __________________________ CONTRACT NUMBER: _______________________

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