Past_Performance_Questionnaire.pdf

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

TO:

RETURN TO: 92 CONS/LGCA

Contracting Officer 110 W. Ent St Fairchild AFB WA 99011

SUBJECT: Present/Past Performance: Contract # ________________________, Contractor: _____________________________

1. Your assistance is respectfully requested in providing information on the attached performance questionnaire. The importance of your opinion cannot be overstated. This survey measures the present/past performance of ______________________________, a prospective offeror for MED 3 services for Fairchild AFB.

2. INSTRUCTIONS FOR COMPLETION: Fill it in by hand or type and please email the results to the Contracting Officer, Richard Kim at richard.kim.10@us.af.mil and to the Administrator, John S.

Havens at john.havens.4@us.af.mil. Email submissions are preferred. You can also send by mail to the address listed above or send by facsimile to commercial phone number (509) 247-8251. Please direct questions to John Havens (509) 247-4873. Your participation is greatly appreciated.

Explanation of codes:

Code PERFORMANCE LEVEL

RATING DEFINITION

Su Substantial Confidence Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.

Sa Satisfactory Confidence Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.

L Limited Confidence Based on the offeror’s recent/relevant performance record, the Government has a low expectation that the offeror will successfully perform the required effort.

N No Confidence Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.

U Unknown Confidence (Neutral)

No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

Circle the appropriate letter for each item on the questionnaire and provide narrative justification.

PLEASE RETURN NO LATER THAN:

Attachment 4

30APR2014

mailto:richard.kim.10@us.af.mil mailto:john.havens.4@us.af.mil

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

I. CONTRACT INFORMATION: Complete the following information on:

a. Contractor (Company/Name/address):

b. Contract:

1. Number:

2. Period of Performance: From: To:

3. Total Contract Amount:

II. RESPONDENT IDENTIFICATION: Complete the following information on your company. You may be contacted for additional information pertaining to the past/present performance of the contractor identified in section I above. (The following information will assist in the analysis of the data. Information will be kept confidential)

a. Name:

b. Position and Title:

c. Phone Number:

d. Address:

CONTRACTOR PRESENT/PAST PERFORMANCE EVALUATION

1. How effective was the contractor in maintaining professional business relationships with government personnel and in resolving contact issues?

Su Sa L N U

COMMENTS/REMARKS:

2. How effective was the contractor’s recruitment plan for filling the required positions and providing replacements for personnel that discontinued employment under the contract?

3. How well did contractor personnel perform assigned protestant religious educational worker duties?

4. How well did personnel perform records management and documentation?

5. Has the Contractor ever been given a Cure Notice, Show Cause Notice, Letter of Concerns, Corrective Action Report, or had payment withheld for services not rendered?

Yes or No. If the answer is yes provide a detail explanation.

6. What is your overall rating of this Contractor?

7. Were there any Contractor Evaluation criteria that we failed to address? If so, what were they?