B-17 - PPQ - as of 15 Dec 09.doc

PPT

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104 SUBJECT: Request for Past Performance Evaluation

TO: Whom it May Concern

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Corrosion Control Services contract at Travis AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, contact the Contract Specialist, Bernadette Cruz Breeding, at (707) 424-7734 or bernadette.breeding@travis.af.mil.

CORA L. ARMSTRONG

Contracting Officer

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Past and Present Performance Questionnaire

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PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Contractor’s responding to solicitation FA4427-09-R-0017 shall send this Past Performance Questionnaire for their references to fill out.

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: _____________________ Telephone Number: _____________________________

Address: ______________________________ Fax Number: __________________________________

______________________________ Point of Contact: _______________________________

Project Title and Brief Description of Work: ________________________________________________*

What specific aircraft(s) was included in the performance of the contract and at what wash frequency per year?

Contract Number Provided by Offeror: ___________________ Dollar Amount: ___________________*

Contract Period or Dates of Performance Provided by Offeror: ______________________

* Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

* 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.

B. RESPONDENT INFORMATION:

Name of Respondent:

________________________________ Title: _____________________________

Address: _____________________ Telephone Number: ___________________________________ _____________________________ Fax Number:________________________________________

Email Address: ______________________________________

C. FAX COMPLETED SURVEY FORM TO: bernadette.breeding@travis.af.mil

D. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (1, 2, 3, 4, and 5) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF Limited or No Confidenc.

CONFIDENCE

Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

CONTRACTOR’S NAME: _____________________CONTRACT # ________________________ (Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts.)

Remarks: ____________________________________________________________________________________

Amendment 0005 Dated: 15 Dec 09