Past Performance Questionnaire.doc

PAST AND PRESENT PERFORMANCE SURVEY (Attachment 9)

When Filled In This document Is Source Selection Sensitive Information IAW FAR 2.101 and 3.104

Reference: FA4621-11-R-0011 Repair Fire Department Rec and Living Areas

30 Jun 2011

(Sample Cover Letter)

(Insert this document into a document with your letterhead)

TO: Insert Name and Company of individual completing the questionnaire

FROM: Insert your name and firm

Subject: Request for Past Performance Information, FA4621-110-R-0011, McConnell AFB Multiple Award Construction Contract

1. You have been identified as a point of contact for a past and/or present performance evaluation of the project or contract listed on the attached questionnaire. We are submitting an offer for the Multiple Award Construction Contract Indefinite Delivery Indefinite Quantity contract at McConnell AFB, Kansas. Your assistance in completing the attached questionnaire evaluating our performance and sending it directly to the McConnell AFB contracting office is greatly appreciated. Your prompt attention to this questionnaire is also greatly appreciated. Any questions concerning this request can be forwarded to (fill in name, telephone, email address).

Sincerely

1. Please e-mail the completed past performance survey questionnaire to Patrick Butler at patrick.butler.2@us.af.mil or send via facsimile to (316) 759-5634.

A.

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

Contractor’s Name:

Address: __________________________

Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Number Provided by Offeror:

Dollar Amount:

Contract Period or Dates of Performance Provided by Offeror:

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

B.

RESPONDENT INFORMATION:

Name of Respondent:

_____________________ Title:

Company Name/Address: _____________________ Telephone Number: ___________________ _________________________________________ Fax Number:

Email Address:

C.

E-MAIL COMPLETED SURVEY FORM To patrick.butler.2@us.af.mil or bill.carbrey@us.af.mil or send via facsimile to (316) 759-5634.

D.

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER_______________

Place an “X” in the appropriate column using the definitions matrix above.

The contractor:

Did this project include work on a Department of Defense installation?

YES/NO

YES/NO

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________