Atch 4 Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

The 45th Contracting Squadron is requesting Past Performance information from non-profit organizations. One of these organizations has identified you as a reference to validate their past performance.

Solicitation no. FA252120QB0006 is for commercial, non-personal services to provide faculty and staff to manage and administer the STARBASE Academy (STEM school program for children) Program at Patrick AFB FL.

Please complete the following questionnaire to assist our evaluation of the non-profit contractor’s past performance, and return directly via email no later than 06 Dec 19, 4:30 PM EST to jose.plasencia.2@us.af.mil and jason.pominski@us.af.mil.

RESPONDENT INFORMATION:

Agency/Organization Name:

Point of Contact (POC):

Title of POC:

Telephone:

Email:

NON-PROFIT CONTRACTOR’S REFERENCE INFORMATION:

Contractor Name:

Point of Contact (POC):

Telephone Number:

Email:

CONTRACT INFORMATION:

Contract Number:

Task Order No. (if applicable):

Type of Contract:

Performance Period: (Base plus any options):

Description of Services:

MAGNITUDE

Annual Contract Value:

Total Contract Dollar Value:

COMPLEXITY

Number of faculty and staff:

Number of students taught per year:

Hours of instruction per year:

Grade level(s) taught:

Contractor performed on this contract as:

Please refer to the following assessment definitions to assess the Contractor’s performance in each of the areas listed in this questionnaire:

(E) Exceptional - Performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance 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 Government’s benefit. The contractual performance 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 contained some minor problems for which corrective actions taken by the contractor appear or were resolved satisfactorily.

(M) Marginal - Performance does not meet some contractual requirements. The contractual performance 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 contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

(N) Not Applicable – Unable to assess the area.

CPARS “Quality of Service” Rating Area

Provided qualified faculty and staff IAW the terms and conditions of the contract.

Provided a safe and welcoming teaching environment for all students.

Led the classroom, motivated students, and taught the curriculum.

If other than “Satisfactory,” explain how the performance exceeded or did not meet contractual requirements:

CPARS “Schedule” Rating

Provide qualified staff on time IAW the Terms and conditions of the contract.

Provided timely and complete reports and documentation IAW the Terms and conditions of the contract.

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

CPARS “Management” Rating

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

Minimized amount of and/or resolved customer complaints or performance deficiencies.

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

Would you award this firm another contract:

If you answered “No” provide an explanation:

Was the contract terminated for default or cause:

If you answered “Yes” provide an explanation:

Additional Comments:

Signature: _________________________________________ Date: __________________

Print Name: ________________________________________

Title: ______________________________________________

Telephone: _________________________________________

Thank you for your participation in providing a detailed and accurate history of past performance for this offeror.