PAST PERFORMANCE QUESTIONNAIRE - Repair Holbrook HVAC.pdf

PAST PERFORMANCE QUESTIONNAIRE

Solicitation No. FA301026R0003

Please complete this questionnaire and email to: chance.daisy@us.af.mil and tiffany.aultman@us.af.mil

We are currently preparing our proposal for the 81st Contracting Squadron, Keesler AFB, MS, Solicitation Number: FA301026R0003 for HVAC Repair of Holbrook Manor at Keesler Air Force Base. As part of our proposal, we have listed you as a reference on our performance for this type of service with your agency or company under the previous or ongoing contract listed below. Your input on our performance is therefore requested.

This Questionnaire is due to the Contracting Specialist, SSgt Chance Daisy and Contracting Officer, Tiffany Aultman no later than 11:00 AM CDT on April 27, 2026. The Questionnaire must be submitted directly to the Contracting Officer from a corporate or government email account.

If you will be unavailable on April 27, 2026, for verification (if necessary) of this past performance evaluation, please indicate another point of contact (POC) for the Contracting Officer to contact.

Thank you.

POC/Alternate POC Name:

POC/Alternate POC Phone Number:

POC/Alternate POC Email Address:

Name of Offeror:

Phone Number:

Email Address:

CONTRACT REFERENCED

Contract Number (including Task Order number if applicable):

Contract Value (including all modifications):

Period of Performance:

Name of Person Completing Questionnaire:

Agency/Company:

Title:

Phone:

mailto:chance.daisy@us.af.mil mailto:tiffany.aultman@us.af.mil

Email:

Brief Description of Work Required in the Referenced Contract:

EVALUATION

Please rate the contractor utilizing the guide below. Explanatory narratives giving specific details would be appreciated. Attach additional pages if more space is needed. Evaluation Definitions:

The following definitions should be used in assessing Contractor performance.

Exceptional: Performance EXCEEDS MANY contractual requirements. Performance being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good: Performance EXCEEDS SOME contractual requirements. Performance being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory: Performance MEETS contractual requirements. Performance being evaluated contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal: Performance MEETS SOME contractual requirements. Performance reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginal effective or were not fully implemented.

Unsatisfactory: Performance DOES NOT MEET contractual requirements. Performance contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Not Applicable (N/A): Performance information is not recent or relevant as defined in the solicitation. Unable to provide assessment.

PAST PERFORMANCE EVALUATION

QUALITY

What is your assessment of the Contractor’s ability to meet work requirements and the overall quality of the work?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A Quality of Work

Comments:

SCHEDULE

What is your assessment of the Contractor’s ability to provide end-products timely?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A Timeliness Ability to Resolve Timeliness Problems

Comments:

MANAGEMENT

What is your assessment of the Contractor’s ability to manage all aspects of the work?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A Managing Work Aspects

Comments:

REGULATORY COMPLIANCE

What is your assessment of the Contractor’s ability to meet all regulatory requirements? Examples would include safety regulations, Davis-Bacon Act and other labor standards.

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A Complying with Regulations

Comments:

OVERALL RATING OF CONTRACTOR’S PERFORMANCE

What is your overall rating of the Contractor’s performance on the contract being assessed.

Exceptional Very Good Satisfactory Marginal Unsatisfactory

General Comments: