Past Performance Questionnaire.pdf

WHEN FILLED IN - SOURCE SELECTION SENSITIVE INFORMATION - SEE FAR 2.101 and 3.104

FOR OFFICIAL USEONL Y

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive lAW FAR 2.101 and FAR 3.104

TO: Whom it May Concern

SUBJECT: Request for Past Performance Evaluation

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 Base Laundry Services contract at Travis AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. Return completed survey to contract specialist listed in section C of the attached questionnaire. If you have any questions concerning this request, contact the Contract Specialist, Kyle Krieman, at (707) 424-7722 or kyle.krieman@travis.af.mil.

G~cj~

PAMELIA C. FRY

Contracting Officer

Attachment:

Past Performance Questionnaire

WHEN FILLED IN - SOURCE SELECTION SENSITIVE INFORMATION - SEE FAR 2.101 and 3.104

FOR OFFICIAL USE ONL Y

mailto:kyle.krieman@travis.af.mil.

FOR OFFICIAL USE ONLY

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Contractor's responding to solicitation FA4427-lO-R-0008 shall send this Past Performance

Questionnaire for their references to jill out

A. GENERAL INFORMATION (contractor responding to the solicitation):

Contractor's Name: ---------Address: _ Telephone Number: _ Fax Number: _ Point of Contact: _

(The offeror will enter this information if the solicitation requires him to submit questionnaires.)

Project Title and Brief Description of Work: * o Bed Linens o 99,999 Ibs per yr or less

[] Bath Linens 0 Table Linens 0 Clothing Items o 100,000 - 499,999 Ibs per yr D 500,000 Ibs per yr or more

Contract Number Provided by Offeror: Lbs/Dollar Amount Per Yr: *

Contract Period or Dates of Performance Provided by Offeror: * Contractor performed as the 0 Prime Contractor 0 Sub-Contractor 0 Key Personnel

B. RESPONDENT INFORMATION (reference filling out the questionnaire):

I

Name of Respondent: _________ Title: _

Address: _ Telephone Number: _ Fax Number:

Email Address:

C. FAX COMPLETED SURVEY FORM TO: Kyle Krieman no later than _ fax 707-424-0288 or email kyle.krieman@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 4 or 5.

Based on the offeror's performance record, the government has a high expectation that the offeror will successfully perform the required effort.

Based on the offeror's performance record, the government has an expectation that the offeror will successfully perform the required effort.

Based on the offeror's performance record, the government has a low expectation that the offeror will successfully perform the required effort

Based on the offeror's performance record, the government has no expectation that the offeror will successfully -perform the required effort

No performance record is identifiable or the offeror's performance record is so sparse that no confidence assessment rating can be reasonably assigned.

WHEN FILLED IN - SOURCE SELECTION SENSITIVE INFORMATION - SEE FAR 2.101 and 3.104 mailto:kyle.krieman@travis.af.mil

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

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Provided cleaned linen on time according to delivery schedules.

3. Provided laundry with little or no re-laundering,.damage to articles during the.laundering process, or lost articles.

4. Home office participated in solving significant local problems. .

5. Followed approved quality control plan.

6. Corrected deficiencies intimely manner and pursuant to their quality control procedures.

6. Identified problems as they occurred.

8. Displayed initiative to solve problems.

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

10 Would you award another contract tothis contractor? 1fnot, explain in "remarks

YES/NO

CONTRACTOR'S NAME:

Remarks:

CONTRACT NUMBER