Attachment_5_PP_Questionnaire.doc

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104

KEESLER AFB FULL FOOD SERVICE

PAST PERFORMANCE QUESTIONNAIRE IN RESPONSE TO

SOLICITATION NO. FA301018R0001

Name of firm to be evaluated: ____________________________________________________

The above contractor has identified you or your (Agency) company as a reference for past performance information for the above referenced solicitation. Please complete this survey, evaluating the contractor’s performance under your contract and return it by fax or email to Deitre Browne, Contract Administrator, telephone 228-377-1833, fax 228-377- 3298, email deitre.browne@us.af.mil. If returning by fax, please call to confirm receipt of fax.

If emailing, the email must be encrypted, and must include “Source Selection Information – See FAR 2.101 and 3.104” in the subject line of the email. Otherwise, the the information may be transmitted via the AMRDEC SAFE at https://safe.amrdec.army.mil/safe/guide.aspx .

It is requested that you complete the following information and provide your assessment.

Thank you for your assistance in the Past Performance evaluation process!

Name & Title of Evaluator:_______________________________________________________

Organization Name: __________________________ Phone No: ________________________

Type of Services Provided: ______________________________________________

Contract Number: ______________________________________________________

Total Contract Amount (includes mods and options): $____________________* Period of Performance Including Option Years (exact dates):____________________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Please circle which efforts were performed under this contract:

1. Food Preparation

4. Dining Facility Management

7. Cashier Service

2. Food Serving

5. Menu Posting

8. Equipment Maintenance/Repair

3. Food Ordering

6. Table Bussing Service

9. Housekeeping Service Evaluation Scoring Definitions:

CODE

PERFORMANCE LEVEL

EXCEPTIONAL - The contractor’s 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.

VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or was satisfactory.

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.

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/A

NOT APPLICABLE - Unable to provide a score.

NOTE: When indicated, please circle the appropriate number associated with the above adjective, for ratings below satisfactory, please comment.

1. Contractor’s Performance:

a. Food prepared

5 4 3 2 1 n/a

b. Serving of food

c. Ordering of food

d. Dining facility management

e. Menu posting

f. Table bussing

g. Cashier service

h. Compliance with sanitation requirements

i. Housekeeping service 5 4 3 2 1 n/a

j. Equipment maintenance/repair 5 4 3 2 1 n/a

COMMENTS: ____________________________________________________________

2. Management & Resources: Adequate personnel, training, equipment and supplies/materials

a. Adequacy of on-site supervisor’s authority

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

c. Compliance with rules, regulations and support of Agency/base programs/policies

(i.e. EEO, Sexual Harassment, Emergency Management)

d. Personnel were well groomed, trained, and possessed expertise necessary for successful performance

e. Contractor’s invoices/reports submitted on time

f. Personnel were trained and possessed expertise necessary for successful contract performance

g. Ability to follow and monitor the Quality Control Plan

h. Care for facilities and equipment provided for use under contract (maintenance, repairs, reporting damage)

i. Meal service during an emergency or contingency operation

j. Flexibility and reasonableness with meeting mission requirements, particularly when faced with short notice mission changes

COMMENTS: ____________________________________________________________

3. Quality of Work and Timeliness: Services performed timely

a. Patrons served IAW scheduled times

b. Cure or Show Cause ever issued for late/nonperformance

c. Contractor compliance with Work Statement

d. Provided effective quality control and/or inspection procedures to meet contract requirements

e. Corrected deficiencies in timely manner

4. Competence/Customer Satisfaction:

a. Overall customer satisfaction

b. Options not exercised due to poor performance. If yes, comment below Yes No

c. Contract Discrepancy Reports issued

d. Discrepancies were corrected satisfactorily. If no, comment below

e. Recommend doing business with this contractor

Please provide any additional information you feel is important and not covered elsewhere**:

**If applicable, please reference the appropriate question number.

Thank you for your remarks, and be sure to return this form to the Contracting Agency and not to the Contractor you are providing a reference for.

Name of Company Being Evaluated: _________________________

Respondent’s Signature: ___________________________________

Date Completed: _________________