Atch_1F_-_Past_Perf_Questionnaire.docx

ADDENDA TO 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS

ATTACHMENT 1F: PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

1. Contractor: _____________________________________________________________________________

1. Cage Code of contractor contract was awarded to: _________________________________

1. Contract number: _______________________________________

1. Contract type: ______________________________

1. Was this a competitive contract? Yes _____ No ____

1. Period of performance: _________________________________________________________

1. Initial contract cost: $____________________________

1. Current/final contract cost: $_______________________________

1. Reasons for differences between initial contract cost and final contract costs: _________________________

1. Description of service provided:______________________________________________________________

SECTION 2. CUSTOMER OR AGENCY IDENTIFICATION

1. Customer or agency name: _________________________________________________________________

1. Customer or agency description (if applicable): _______________________________________________________________

1. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3. EVALUATOR IDENTIFICATION

1. Evaluator's name: _________________________________________________________________________

1. Evaluator's title: __________________________________________________________________________

1. Evaluator's phone/fax number: ______________________________________________________________

D. Number of years evaluator worked on subject contract: _____________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE RATING

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

V VERY GOOD (V) – Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

S SATISFACTORY (S) – Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL (M) – Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY (U) – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE (N) – Unable to provide a rating. Contract did not include performance on this element or sub-element, or information was not available. Do not know.

The Contractor:

Sub-Factor 3: Transition

Customer Satisfaction/General Information

Yes ______ No______

Yes ______ No______

Yes ______ No______ If yes, please explain

2. Please discuss each and every response for which you indicated E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions above, use additional sheets, if necessary

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

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

SECTION 5: NARRATIVE SUMMARY

What were the contractor’s most positive aspects in the performance of the contract?

What were the contractor’s most negative aspect in the performance of the contract? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

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

Evaluator’s Signature Date Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Email Address: theresa.bryant@us.af.mil, sharon.boren@us.af.mil Or FAX to: 402-294-0430 (COMM), 271-0430 (DSN)

FA4600-13-R-0002 PMEAS II Attachment 1F Pages 7