Past Performance Questionnaire.docx

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 5TH MISSION SUPPORT GROUP (ACC)

MINOT AIR FORCE BASE, NORTH DAKOTA

FA4528-10-R-0002

Attachment 4

MEMORANDUM FOR PROSPECTIVE EVALUATORS

FROM: 5th Contracting Squadron/LGCS 211 Missile Ave Minot AFB, ND 58705-5027

SUBJECT: Past Performance Questionnaire

1. The 5th Contracting Squadron, Minot AFB, North Dakota, is in the process of selecting a contractor for Packing, Containerization and Local Drayage of Direct Procurement Method (DPM) Personal Property Shipments.

2. One of the considerations in proposal evaluation is the verification of the Offeror’s past and present performance on contracts, which reflect the Offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had first hand experience with an Offeror, for the evaluation of the Offeror's performance on those contracts.

3. Our areas of interest in the Offeror are summarized in the enclosed questionnaire. Please complete this questionnaire by indicating your rating and providing comments wherever applicable. For any ratings above or below satisfactory, please provide an explanation on how the contractor either exceeded your requirement or how the contractor failed to meet your requirement and attach it to your response. This can be a copy of a performance evaluation, discrepancy report, or other documentation. Once complete, please sign the document in the space provided.

4. Please note, we may contact the Offeror on problem areas or concerns identified to see what corrective actions have been taken or will be taken. However, the individual's name completing the questionnaire will not be disclosed to the Offeror.

5. Your time and effort in providing this vital information is greatly appreciated and is critical to our evaluation. Please return the completed questionnaire as soon as possible but no later than the offer due date noted in the Solicitation. Please obtain this date from your Packing & Crating contractor. The completed document should be marked Source Selection Sensitive/For Official Use Only. You may fax it to (701) 723-2895, attention A1C Todd Tevis or mail it to the following address:

5 CONS/LGCS

ATTN: A1C Todd Tevis 211 Missile Ave Minot AFB, ND 58705-5027 Email: todd.tevis@minot.af.mil

6. If you have any questions, please contact A1C Todd Tevis, Contract Administrator, at (701) 723-7080 or DSN 453-7080. Thank you for your cooperation and quick response to this request.

//SIGNED//

Attachment:

Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

PACKING AND CRATING SERVICES

(THE OFFEROR SHALL PROVIDE THIS ATTACHMENT TO CUSTOMERS, INDIVIDUALS OR OTHER GOVERNMENT OFFICES WHO HAVE KNOWLEDGE OF THE OFFEROR'S PAST AND PRESENT PERFORMANCE)

Please fax or mail the completed questionnaire no later than the offer due date located in the Solicitation (verified with your Packing and Crating contractor) to:

A1C Todd Tevis

5 CONS/LGCS

211 Missile Ave.

Minot AFB, ND 58705-5027 Fax: (701) 723-2895 Email: todd.tevis@minot.af.mil

Part 1: CONTRACT IDENTIFICATION

********************The Contractor Must Fill out This Section********************

(Customer must circle concur or does not concur on the following page)

Contract Information: Complete the following information on the contractor that provided or is currently providing services for your company.

a. Contractor’s Name/Address/Phone:

b. Contract Number: _________________________

c. Program Title: ____________________________

d. Contract Type: |_| Firm-Fixed-Price |_| Indefinite-Delivery/Indefinite Quantity |_| Cost-Reimbursement

e. Period of Performance of the contract: _______________________

f. Period of Performance you are assessing: _________________________

g. Base Period Contract Dollar Value: ______________________

h. Total Contract Dollar Value (including all option periods): __________________________

i. Description of service provided: (Please include any unusual or special requirements)

Part 2: EVALUATION

*********************The Customer Must Fill Out Remaining Sections*********************

Customer concurs / does not concur with contractor’s statements on previous page.

Performance Information: Please indicate your satisfaction with the contractor’s performance by circling the appropriate rating using the scale provided. For ratings above or below satisfactory, please comment on how the contractor either exceeded your requirement or how the contractor failed to meet your requirement. If the contractor had problems in a specific area, but you determined them to have no impact on the mission, please specify this in your narrative remarks. If the statement is not applicable, circle N for “Neutral”.

When responding to this questionnaire, please use the following definitions as a guide:

Performance Confidence Assessment

N. No 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.

U. Unknown No performance record is identifiable or the offeror’s performance record is so limited that no confidence assessment rating can be reasonably assigned.

1. PERFORMANCE REQUIREMENTS

COMMENTS/REMARKS:

2. MANAGEMENT EFFECTIVENESS

COMMENTS/REMARKS:

3. QUALITY OF SERVICE AND WORKMANSHIP

COMMENTS/REMARKS:

4. TIMELINESS/ADHERENCE TO SCHEDULES

COMMENTS/REMARKS:

5. QUALITY CONTROL

COMMENTS/REMARKS:

6. CUSTOMER SATISFACTION

COMMENTS/REMARKS:

7. COMPLIANCE WITH ENVIRONMENTAL/LABOR/SAFETY REQUIREMENTS

COMMENTS/REMARKS:

1. Did the contractor respond in a timely manner to claims for breakage/damage/missing items and quickly reimburse the customer?

|_| Yes (please explain) |_| No

COMMENTS/REMARKS:

2. During the course of the contract, was notification sent to the contractor identifying unsatisfactory work?

|_| Yes (please explain) |_| No

COMMENTS/REMARKS:

3. Has the contractor ever been given a cure notice, a show cause notice, a suspension of payment, or had a claim denied?

COMMENTS/REMARKS:

4. Based on your judgment of the contractor’s performance, would you award the contractor another Government contract?

COMMENTS/REMARKS:

5. Please rate the overall consistency and reliability of the contractor’s performance.

Exceptional Very Good Satisfactory Neutral Marginal Unsatisfactory

COMMENTS/REMARKS:

6. Please rate overall customer satisfaction with the contractor's performance.

Exceptional Very Good Satisfactory Neutral Marginal Unsatisfactory

COMMENTS/REMARKS:

Part 3: EVALUATOR INFORMATION

The following information will help us track the responses received, as well as resolve whatever differences may arise between your perception of the contractor’s performance and the contractor’s perception of their performance. You are advised that the Air Force FAR Supplement (AFFARS) requires that the Offeror be given an opportunity to respond to adverse past performance information.

a. Evaluator’s Name:

b. Title:

c. Telephone Number: DSN: Commercial:

d. Organization, Office Symbol, and Address:

e. Length of involvement in the contract:

f. Date of questionnaire completion:

Again, thank you for your time and effort in assisting us with our requirement.

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