Overhead_Doors_and_Gates_-_Questionnaire.doc

FA4417-16-T-0003 Attachment 3

DEPARTMENT OF THE AIR FORCE

1ST SPECIAL OPERATIONS CONTRACTING SQUADRON (AFSOC)

HURLBURT FIELD FLORIDA

MEMORANDUM FOR (Offeror please add reference information)

FROM: (Offeror insert your company name here) for 1 SOCONS/LGCA

350 Tully Street, Bldg 90339

Hurlburt Field, FL 32544fillin "Enter your THREE LINE ADDRESS (Press [SHIFT] + [ENTER] to start a new line)"

SUBJECT: Request for Past Performance Questionnaire Information for FA4417-16-T-0003, Overhead Doors and Gates Maintenance and Repair Services, Hurlburt Field, FLfillin "Enter the SUBJECT"

1. You have been identified as a reference point of contact for past and/or present performance evaluation of the firm listed on the attached questionnaire form. This firm is currently interested in providing a proposal for Overhead Doors and Gates Maintenance and Repair Services at Hurlburt Field, FL.

2. Please complete the attached questionnaire and return no later than 2 April 2015. Please e-mail the survey to Mr. David Jesmain (David.Jesmain.1@us.af.mil) -AND- SSgt Kelly Martin (kelly.martin.12@us.af.mil).

3. If you have any questions, please contact SSgt Kelly Martin at (850) 884-7794 or Mr. David Jesmain at (850) 884-3262.

4. Your information MUST be submitted by 12:00 p.m. Central Standard Time (CST) on 8 February 2016. This information is vital when performing source selection. Your expedited attention regarding this matter is greatly appreciated. Thank you in advance.

<SIGNED>

DAVID P. JESMAIN

Contracting Officer

Attachment:

Past and Present Performance Questionnaire

PRESENT AND PAST PERFORMANCE QUESTIONNAIRE

Solicitation Number FA4417-16-T-0003 Overhead Doors and Gates Maintenance and Repair Services at Hurlburt Field, FL

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104 Contractor please complete section A. General Information before sending to your reference:

A. GENERAL INFORMATION:

Contractor’s Name: ___________________________________ Address:

E-mail Address: _______________________________________ Telephone Number: ___________________________________ Point of Contact:

Project Title:

Description of Work: ___________________________________

Contract Number: ______________________________________ Dollar Amount: $ _______________per____________________ Contract Period:

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the:

· Prime Contractor Sub-Contractor Key Personnel Contractor performance under this contract was for Overhead/Automtic Doors and Electric Gate Preventative Maintenance and Repair to include:

Yes No

1. Experience that includes inspection, maintenance, and repair services for overhead doors within the last five (5) years.

Yes No

2. Experience that includes inspection, maintenance, and repair services for automatic doors within the last five (5) years.

Yes No

3. Experience that includes inspection, maintenance, and repair services for electric gates within the last five (5) years.

Respondent please complete the remainder of this document and email to David Jesmain: David.Jesmain.1@us.af.mil -AND- Kelly Martin: kelly.martin.12@us.af.mil NLT 12:00 p.m. Central Standard Time (CST) on 8 February 2016:

B. RESPONDENT INFORMATION:

Name of Respondent:

Title:

Company Name/Address:

Telephone Number:

Fax Number:

E-mail Address:

C. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF “M” OR “U”.

The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub- element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

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

YES / NO

NO

NO

N/A

Remarks:

Please sign and date below.

(Signature)

(Date)

� EMBED Word.Picture.8 ���

Attachment #3

Past and Present Performance Questionnaire

_1486451708.doc