Attachment_10_Past_Performance_Questionnaire.docx

FA4460-17-R-0004

Past Performance Questionnaire

The 19th Contracting Squadron of the Air Force Air Mobility Command is in the process of competitively selecting a source for a construction program. This requirement is for the IDIQ Civil Works contract, Little Rock Air Force Base, Arkansas. The contractor is required to provide all services necessary for the completion of the projects.

One of the considerations in proposal 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 10 calendar days prior to proposal due date. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to nicholas.evans.12@us.af.mil and rachel.italiano.1@us.af.mil. Your completed questionnaire will become a part of the official source selection records.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Signature Jesse L. Christy Contracting Officer

Atch

MEMORANDUM FOR (Contractor please add reference information)

FROM: 19 CONS/LGCA

SUBJECT: Request for Past Performance Questionnaire Information for FA4460-17-R-0004 Little Rock Air Force Base IDIQ Civil Works

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 the above reference project.

2. Please complete the attached survey questionnaire. You should e-mail the survey back to 2Lt Nicholas Evans at nicholas.evans.12@us.af.mil. Also send a copy to Rachel L. Italiano at rachel.italiano.1@us.af.mil. If you have any questions, please contact 2Lt Nicholas Evans at (501) 987-3855 or Rachel L. Italiano at (501) 987-3847. Your information MUST be submitted by 5 Jun 2017@ 12:00PM LOCAL (CST). Your expedient attention regarding this matter is greatly appreciated. Thank you in advance.

Attch

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name: _______________________________ Telephone Number: ______________________________ Fax Number: ____________________________________ Point of Contact: _________________________________ Project Title: ___________________________________________________________________ Description of Work: ___________________________________________________________*

Contract Number: ______________________ Dollar Amount: _________________________* Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.): ____________________________________ 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 5 years, please complete separate evaluation forms for those contracts as well.

Contract Period of Performance:

1. Original Schedule (assuming all options exercised):

Beginning Date ______________ through ________________

2. Current Schedule (assuming all options exercised):

Beginning Date ______________ through _________________

3. Reason for difference (if applicable):

B. RESPONDENT INFORMATION:

Customer or Agency Name: ____________________________ Name of Respondent: _________________________________ Title: ______________________________________________ Telephone Number: __________________________________ Fax Number: _______________________________________ Email Address: ______________________________________ Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role: _____________________________________________________

C. EMAIL COMPLETED SURVEY FORM TO: 2Lt Nicholas Evans or Rachel Italiano 501-987-3855

D. 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:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

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.

SUPPORTING INFORMATION:

EXPLANATION:

☐ Yes ☐ No

EXPLANATION:

☐ Yes

Additional Remarks: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Attachment 10