Past_Performance_Questionnaire.docx

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

Past Performance Questionnaire – Grease Trap Maintenance The 375th Contracting Squadron, Air Mobility Command at Scott Air Force Base (AFB), Illinois is in the process of competitively selecting a source for all labor, transportation, materials and equipment to clean and remove grease, fats and oils in various buildings located at SAFB.

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 enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than 09 September 2019. 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 may be filled out electronically and e-mailed to joseph.bernier@us.af.mil. Please call Technical Sergeant Joe Bernier at 618-256-9251 if you have any questions. Your completed questionnaire will become a part of the official award records.

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

JOSEPH P. BERNIER, TSgt, USAF 375 Contracting Squadron Scott AFB, IL 62225-5015

1 Attachment :

Past Performance Questionnaire

Section 1: Contract Identification

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 Identification

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:

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.

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 qualified personnel, if necessary.

☐ 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 OSHA and other applicable food safety codes:

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. 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: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. The Contractor being considered for award:

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

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. The Contractor being considered for award:

Receptive to contract change(s).

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________

8. The Contractor being considered for award:

Submitted invoices/billing in a timely manner with minimal delay and mistakes.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. The Contractor being considered for award:

Promoted good working relationships.

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

SUPPORTING INFORMATION: ______________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. 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

12. The Contractor being considered for award:

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

☐ YES ☐ NO

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).

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 [ click and select an item ] award to them today given that I had a choice.

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: joseph.bernier@us.af.mil AND marcia.wuebbels@us.af.mil

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