4._Past_Performance_Questionnaire.pdf

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire – Fire Alarm Maintenance and Fire Extinguisher Inspection

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The 375 Contracting Squadron, Air Mobility Command at Scott Air Force Base (AFB), Illinois is in the process of competitively selecting a source to provide all management, tools, supplies, equipment, and labor necessary to inspect, test, repair, and maintain automatic fire alarm and mass notification systems at Scott AFB, IL in a manner that will ensure their serviceability and operation. Fire alarm and mass notification systems include but are not limited to panels, associated devices/components/wiring, pull stations, radio transceivers, and directly connected fire suppression panels/interfaces. In addition, the contractor shall also provide fire extinguisher maintenance as required by the Scott AFB Fire Department.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the questionnaire on the proceeding pages. In order to meet the acquisition milestones, we request your written response no later than 21 September 2018. This schedule will allow us sufficient time to analyze the data prior to award.

To assist you in preparing your response and expediting your reply, the questionnaire shall be filled out and e-mailed directly to scott.ray@us.af.mil and marcia.wuebbels@us.af.mil. Please call Technical Sergeant Scott Ray at 618-256-9251 if you have any questions. Your completed questionnaire will become a part of the official award records.

Please fill out the applicable information on page 2 of this document and then read and understand the EXCEPTIONAL – UNSATISFACTORY rating found on page 3. Page 4 begins the questionnaire and this is where your input and information is most vital.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this award.

SCOTT M. RAY, TSgt, USAF 375 Contracting Squadron Scott AFB, IL 62225-5015

1 Atch Past Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836 mailto:scott.ray@us.af.mil

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Section 1: Contract Identif ication

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type:

E. Description of work performed for your company:

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

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

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract:

Section 3: Respondent Identif ication

A. Respondent’s name:

B. Respondent’s title:

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

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

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

F. Other suggested points of contact:

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Section 4: Performance Information

In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under 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.

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A. TECHNICAL FACTORS – Rate the Contractor’s performance for the following:

1. The Contractor being considered for award:

Provided experienced managers, supervisors, and technicians with the technical and administrative abilities needed to meet contract requirements.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: _______________________________________________________________

2. The Contractor being considered for award:

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________

3. The Contractor being considered for award:

Followed and satisfied contractual/project requirements.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________

4. The Contractor being considered for award:

Followed and complied with the following work and inspection codes:

• UFC 3-601-02

• NFPA Standards current at time

• Manufacturer’s Instructions

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION:

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5. The Contractor being considered for award:

All technicians assigned to provide fire detection and/or extinguisher service(s) maintained current applicable National and State certification.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________

6. The Contractor being considered for award:

Corrected deficiencies and/or satisfied service requirements in a timely manner pursuant to contractual/project requirements.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________

7. The Contractor being considered for award:

After hours response service times were always met.

SUPPORTING INFORMATION: ______________________________________________________________

8. The Contractor being considered for award:

Responsive to contract change(s) (if applicable).

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9. The Contractor being considered for award:

Receptive to contract change(s).

10. The Contractor being considered for award:

Submitted invoices/billing in a timely manner with minimum delay.

11. The Contractor being considered for award:

Promoted good working relationships.

12. How would you rate the contractor's overall performance?

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13. The Contractor being considered for award:

Was the contractor ever issued a citation or notice of violation under the referenced contract? If yes, explain outcome in “remarks.”

☐ YES ☐ NO

14. The Contractor being considered for award:

Would you award another contract to this contractor? If not, explain in “remarks.”

☐ YES ☐ NO

Please provide the following information regarding cost/price:

(1) Original Contract Cost/Price $

(2) Value of Negotiated Contract Changes $

(3) Actual Cost to Complete $

(4) Price of Auger Repair/Replacement $

(5) Price of DCU Repair/Replacement $

(6) Cost Under run/Over run (-) $

ADDITIONAL REMARKS:

Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations?

☐ Yes ☐ Default ☐ Convenience ☐ Pending Terminations ☐ No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

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C. GENERAL COMMENT (Choose one of the following and explain your choice in the remarks)

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I award to them today given that I had a choice.

REMARKS:

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: scott.ray@us.af.mil AND/OR marcia.wuebbels@us.af.mil

Mail to:

201 East Winters Street (Bldg. 50) Scott AFB, IL 62225-5015 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 mailto:scott.ray@us.af.mil