Attachment 4 - Past Performance Questionnaire 29 Oct 2021.docx

Past Performance Questionnaire

The 1st Special Operations Contracting Squadron at Hurlburt Field, FL is competitively selecting a source for Information Management / Information Technology (IM/IT) Services Support.

One of the considerations in the 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 9 November 2021. This schedule will allow sufficient time to analyze the data.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to kathryn.kester@us.af.mil and cecile.bodison@us.af.mil. Please confirm receipt of the questionnaire. For questions, please contact Kathryn Kester at (850) 884-3268 or Cecile Bodison at (850) 884- 7692.

CECILE A. BODISON CONTRACTING OFFICER

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

FA441721Q0027

Attachment 4

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. Program Description:

G. Period of Performance

3. Reason for difference (if applicable):

H. 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):

I. Description of work performed:

J. Workload:

1. How many network users were served?

2. How many network devices were serviced?

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

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire

FA441721Q0027

Attachment 4

Note: If offeror holds or has held other contracts for Information Management / Information Technology (IM/IT) Services Support 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:

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.

1. Provided qualified personnel IAW the terms and conditions of the contract. SUPPORTING INFORMATION:

2. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

SUPPORTING INFORMATION:

3. Provided effective quality control to meet contract requirements. SUPPORTING INFORMATION:

4. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

SUPPORTING INFORMATION:

5. Was responsive to contract changes. SUPPORTING INFORMATION:

6. How would you rate the contractor's overall performance on this contract? SUPPORTING INFORMATION:

7. Was the contractor ever issued a letter of concern, cure notice, or show cause notice under the referenced contract? If yes, explain.

EXPLANATION:

· Yes

· No

· No

· No

· No

· No

· No

Additional 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: kathryn.kester@us.af.mil and cecile.bodison@us.af.mil image2.png image3.png image1.png