Past_Performance_Questionnaire.pdf

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

Past Performance Questionnaire

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The 87th Contracting Squadron of the Air Force in the process of competitively selecting a source for Portable Latrine Services.

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 May 15, 2018 at 3:00pm EST.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to amber.molina@us.af.mil or by hand and faxed to 609 754-4948 (Attention: Mrs. Amber Molina).

Please call Mrs. Molina at 609 754-4408 prior to fax transmission or if you have any questions.

Your assistance and your prompt response will be is greatly appreciated.

CHRISTINE T. LEHTINEN

Contracting Officer

1 Atch http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836

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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. Period of Performance

F. Contract Dollar Value

G. Description of work performed:

H. How is this requirement relevant to the solicitation?

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

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

Section 4: Performance Information

In the tables 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

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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.

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Performance E V S M U N/A

1. Did the contractor provide portable latrine and handwashing station services to include servicing and maintaining?

SUPPORTING INFORMATION:

2. Was the contractor knowledgeable about servicing and maintaining portable latrines and handwashing stations?

3. Was the contractor able to relocate portable latrines and handwashing stations?

4. Did the contractor service, maintain and relocate portable latrines and handwashing stations on time?

5. Did the contractor respond to service calls in timely manner?

6. Did the contractor adhere to Occupational Safety and Health Standards?

7. How timely and effectively did the contractor resolve contract problems without extensive Government guidance?

8. How successfully did the contractor respond to emergency and/or surge situations?

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9. Overall, how would you rate this contractor?

Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations?

☐ Yes ☐ Default ☐ Convenience ☐ Pending Terminations ☐ No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I ___________________ award to him today given that I had a choice.

REMARKS:

Please provide any additional comments concerning this contractor’s performance, as desired.

Respondent’s Signature & Phone Number Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to: