Attachment_5_-_Past_Performance_Questionaire-signed.pdf

Attachment 5 – FA330019RA001

PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Request for Current and Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation from . This firm is currently being considered for a contract with the Government for providing Purchase Agents for Air Force Credentialing Opportunities On-Line (COOL) support for Maxwell Air Force Base Gunter Annex, AL.

A member of the Past Performance team will be contacting you to telephonically complete the attached questionnaire. If you have any questions concerning this request contact Karyn Williams at karyn.williams@us.af.mil and LaChandra Thompson at lachandra.thompson@us.af.mil.

Thank you, GLADYS S. JOHNSON

Contracting Officer 42d Contracting Squadron

WHEN FILLED IN, THIS DOCUMENT IS SOURCE SELECTION

SENSITIVE IN ACCORDANCE WITH FAR 2.101 and 3.104 mailto:karyn.williams@us.af.mil mailto:lachandra.thompson@us.af.mil

PAST PERFORMANCE QUESTIONNAIRE

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

Section 4: Performance Information

In the table below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided.

Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed 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 the

Government’s benefit. The contractual performance being assessed 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 being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

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

The contractor: E V S M U N/A

1. Credentialing exam and materials payments maintained in the required system.

2. Preapred and submit all required contract deliverables, as required.

3. Receipts for all transactions loaded to each individual’s record, as required.

4. Exam scores are loaded in the required system, as required.

5. Monthly invoices submitted to the required system for processing, as required.

6. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

7. Would you award another contract to this contractor? If not, explain in “remarks.” YES/NO

Explanations/Remarks:__________________________________________________________________________

[click and pick the date] Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: karyn.williams@us.af.mil and lachandra.thompson@us.af.mil mailto:karyn.williams@us.af.mil mailto:lachandra.thompson@us.af.mil