Attachment_3_-_Past_Performance_Questionnaire.docx

FA4427-17-R-0101

(CONTRACTOR LETTERHEAD)

MEMORANDUM FOR (Offeror please add reference information)

FROM: (Offeror insert your company name here) for 60 CONS/LGCA 350 Hangar Ave Bldg 549 Travis AFB, CA 94535-2632

SUBJECT: Request for Past Performance Questionnaire Information for FA4427-17-R-0101, Base Paint, Striping, Marking, and Signage, Travis AFB, CA

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 Base Paint, Striping, Marking, and Signage Basic Ordering Agreement at Travis AFB, CA.

2. Please complete the attached survey questionnaire and return no later than 15 FEBRUARY 2017. Please e-mail the survey back to SSgt C. Byron Wilson (charles.wilson.43@us.af.mil) and toVallarie Kilkenny (vallarie.kilkenny@us.af.mil).

3. If you have any questions, please contact Ms. Vallarie Kilkenny at 707-424-7769

4. Your information MUST be submitted by 15 FEBRUARY 2017. Your expedient attention regarding this matter is greatly appreciated. Thank you in advance.

(CONTRACTOR’S SIGNATURE BLOCK)

PRESENT AND PAST PERFORMANCE QUESTIONNAIRE

Solicitation Number FA4427-17-R-0101 Base Paint, Marking, Striping, and Signage Travis AFB, CA

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

A. GENERAL INFORMATION:

Contractor please complete block A before sending to your reference.

Contractor’s Name:

Address:

Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Number Provided by Offeror: Dollar Amount: $

Contract Period or Dates of Performance Provided by Offeror:

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.

B. RESPONDENT INFORMATION:

Name of Respondent:

Title: Company:

Address:

Telephone Number:

Fax Number:

Email Address:

C. PERFORMANCE INFORMATION:

Circle the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF MARGINAL OR UNSATISFACTORY. Comments for ratings of Very Good or Exceptional would be appreciated.

Rating key to assist in completing the questionnaire:

Based on the offeror’s performance in the following areas the ratings are:

N U M S VG E N/A

PERFORMANCE/PROGRAM MGMT

1. Upon award the contractor was timely in 1 2 3 4 5 6 N/A fulfilling contract requirements (submitting documents, starting work, submitting materials & acknowledgements, etc)?

2. Cooperated with owner/government personnel 1 2 3 4 5 6 N/A after award.

3. Demonstrated ability to hire, maintain & 1 2 3 4 5 6 N/A replace if necessary, qualified personnel during the contract period.

4. Provided experienced employees with the 1 2 3 4 5 6 N/A technical & administrative abilities to meet contract requirements.

5. Provided material submittals in accordance 1 2 3 4 5 6 N/A with the contract requirements.

6. Provided payrolls in a timely manner. 1 2 3 4 5 6 N/A

7. Maintained a single point of contact to 1 2 3 4 5 6 N/A manage and resolve problems.

8. Provided adequate employee supervision. 1 2 3 4 5 6 N/A

9. Company headquarters participated in solving 1 2 3 4 5 6 N/A significant local problems.

10. Corrected deficiencies in a timely manner & 1 2 3 4 5 6 N/A pursuant to their quality control procedures.

11. Met established turn around times 1 2 3 4 5 6 N/A for required periodic contract reports, etc.

12. Identified risks/problems as they occurred. 1 2 3 4 5 6 N/A

13. Suggested alternative approaches to problem. 1 2 3 4 5 6 N/A

14. Was responsive to contract changes. 1 2 3 4 5 6 N/A

15. Effectively managed sub-contractor 1 2 3 4 5 6 N/A efforts.

EMPLOYEE RETENTION

1. Demonstrated ability to retain a qualified 1 2 3 4 5 6 N/A workforce.

INVOICING & PROGRESS REPORTS

1. Provided accurate and timely invoices. 1 2 3 4 5 6 N/A

2. Provided accurate and timely progress reports 1 2 3 4 5 6 N/A

ORGANIZATION

1. Has demonstrated good organizational 1 2 3 4 5 6 N/A structure and accountability.

2. If there were problems with the on site supervision, Yes ( ) No ( ) N/A ( ) were you able to easily resolve those problems with the company’s management? (Please explain under “remarks”.)

3. Are you aware of any documented organizational Yes ( ) No ( ) N/A ( ) deficiencies with the contractor?

(If yes, please explain under “remarks”.)

LEGAL

1. Are you aware of any legal problems experienced by Yes ( ) No ( ) N/A ( ) the contractor? (Please explain under “remarks”.)

2. Are you aware of any verified ethical problems Yes ( ) No ( ) N/A ( ) experienced by the contractor? (Please explain under “remarks”.)

GOVERNMENT CONTRACTS ONLY

1. Was the contractor ever issued a cure notice Yes ( ) No ( ) N/A ( ) or show cause? If yes, explain outcome in “remarks”.

2. Has the contract been partially or completely terminated Yes ( ) No ( ) N/A ( ) or is the contract pending termination?

2a. If you answered “YES” to question #2, please explain under “remarks”.

3. Has an election ever been made to not exercise an option due to contractor’s performance. Yes ( ) No ( ) N/A ( ) If yes, explain in “remarks”.

3. Was there any specific delivery order that had problems?

(please explain under “remarks” Yes ( ) No ( ) N/A ( )

SUMMARY:

1. Do you have any reservations about having this Yes ( ) No ( ) N/A ( ) contractor perform another contract for you?

(If yes, please explain under “remarks”.)

2. Rate the contractor’s overall performance : 1 2 3 4 5 6 N/A

NARRATIVE SUMMARY

1. What were the contractor’s greatest strengths in performance of the contract?

2. What were the contractor’s greatest weaknesses in performance of the contract?

Please add any additional comments concerning this contractor’s performance.

Remarks:

Please provide the Name, Organization, e-mail and phone number of the Inspector on this contract in the blocks below.

FA4427-17-R-0101

Attachment #3