ATCH 5-Past Performance Questionnaire.doc

Attachment 5

FA4416-08-R-0010

TO: Insert addressee and address

FROM: Insert company name and address

SUBJECT: Request for Past/Present Performance Information

1. You have been identified as a point of contact for a past and/or present performance evaluation of insert company’s name. Insert company’s name is currently being considered for a combined Simplified Acquisition of Base Engineering Requirements (SABER) IDIQ contract at Andrews AFB and Bolling AFB, DC.

2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed worksheet directly Lt Nathaniel Franz at nathaniel.franz@us.af.mil. Worksheets shall not be sent back to insert company’s name. If you have any questions or concerns regarding this request, please contact Lt Nathaniel Franz at 301-981-1958 or by email at the addresses listed above. In the event that email cannot be utilized, the questionnaires can be faxed to 301-981-1907.

Past Performance Questionnaire SECTION A: Contractor Information (to be completed by the contractor requesting information prior to mailing)

A. Contractor’s name and address: ___________________________________________

B. Point of Contact: _______________________________________________________

C. Phone/Fax/Email Address: _______________________________________________

D. Contract Number: ______________________________________________________ E. Project Title/Description of Work: ________________________________________

F. Contract Type: Firm-Fixed Price Indefinite-Delivery/Indefinite-Quantity Cost-Reimbursement

G. Project Award Date: _______________ Scheduled Completion Date ______________

Current/Final Completion Date ____________

H. Project Award Amount: ____________ Current/Final Project Amount _____________

I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier

J. Authorization is hereby granted to provide the information requested in SECTION B of this Questionnaire

(Signature)

(Name and Title of Authorizing Official) (Date)

EVALUATED BY:

(Signature) (Date)

_____________________________________ Address: _____________________________

(Typed or Printed Name) _____________________________________

(Title)

(Phone/Fax/Email)

NOTE: The identity of individual(s) providing reference information shall not be disclosed Additional Information:

(1) Identify the contractor's overall strengths and weaknesses.

(2) Given the choice, would you award to this contractor again?

(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.

(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.

(If more comment space needed, write on back, or attach pages.)

Thank you for taking the time to complete this questionnaire. If you have any additional comments or questions, you can contact Lt Nathaniel Franz at 301-981-1958 / nathaniel.franz@us.af.mil.