Atch 6 - Past Present Performance Questionnaire.pdf

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Attached to
Transient Aircraft & Aircraft Wash Services Federal contract opportunity
Solicitation number
FA4621-12-R-0004
Issued by
Department of the Air Force Air Mobility Command

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Attachment 6 Past and Present Performance Questionnaire for FA4621-12-R-0004 Transient Aircraft and Aircraft Wash Services

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FA4621-12-R-0004 Attachment 6 Transient Aircraft and Aircraft Wash Services Past and Present Performance Questionnaire McConnell AFB Kansas

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

FAR 3.104

SUBJECT: Request for Past Performance Evaluation

TO: _______________________________________

You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for the Transient Aircraft and Aircraft Wash Services contract at McConnell Air Force Base, Kansas.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at (316) 759-4516.

KENNETH A. BUTLER

Contracting Officer

Attachment:

Past and Present Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_629 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5837

Reference: FA4621-12-R-0004, Transient Aircraft and Aircraft Wash Services

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

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: _____________________* Dollar Amount: $_________________ per _________________* 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

A. RESPONDENT INFORMATION:

Name of Respondent: __________________________________ Title: _______________________________________________ Company Name/Address: _______________________________ Telephone Number: ____________________________________ Fax Number: _________________________________________ Email Address: ________________________________________

B. E-MAIL COMPLETED SURVEY FORM TO:

Valerie Brown, luz_valerie.brown@us.af.mil and SrA Christopher Pasco, christopher.pasco.1@us.af.mil mailto:luz_valerie.brown@us.af.mil mailto:%20christopher.pasco.1@us.af.mil

C. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF “M” OR

“U”.

E G S M U N

EXCEPTIONAL

GOOD

SATISFACTORY

MARGINAL

UNSATISFACTORY

NEUTRAL

Performance meets / met contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets / met contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets / met contractual requirements.

The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not / did 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 or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not / did 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.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _____________________________

CONTRACT NUMBER: _______________________________

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

The contractor: E G S M U N

1.

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Provided adequate project supervision.

3.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

The contractor: E G S M U N

4. Home office participated in solving significant local problems.

5. Provided effective quality control and/or inspection procedures to meet contract requirements.

6. Corrected deficiencies in a timely manner and pursuant to their quality control procedures.

7. Identified problems as they occurred.

8. Suggested alternative approaches to problems.

9. Displayed initiative to solve problems.

10. Met established project schedules.

11. Was responsive to contract changes.

12. Complied with all federal, state and local laws and regulations to include appropriate licensing.

13. Complied with all USAF regulations.

14. Cooperated with Government personnel after award.

15. How would you rate the contractor's overall performance?

16. Did this project include work on a flightline?

YES / NO

17. Did this project include work on a military installation?

18. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “Remarks” section.

19. Would you award another contract to this contractor? If not, explain in “Remarks” section.

20. Is the contractor rated in CPARS?

Remarks: _______________________________________________________________

Signature of Reviewer Date

Contractor's Name:
Address 1:
Address 2:
Telephone Number:
Fax Number:
Point of Contact:
Project Title 1:
Project Title 2:
Project Title 3:
Contract Number Provided by Offeror:
Dollar Amount:
Performed As: Off
Name of Respondent:
Title:
Company Name/Address:
Telephone Number 2:
Fax Number 2:
Email Address:
Contract Period or Dates of Performance Provided by Offeror 2:
CONTRACTOR'S NAME:
CONTRACT NUMBER:
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
7: Off
8: Off
9: Off
10: Off
11: Off
12: Off
13: Off
14: Off
15: Off
16: Off
17: Off
18: Off
19: Off
20: Off
Remarks:
Remarks 10:
Remarks 11:
Remarks 1:
Remarks 2:
Remarks 3:
Remarks 9:
Remarks 8:
Remarks 7:
Remarks 6:
Remarks 5:
Remarks 4:
Remarks 12:
Remarks 13:
Remarks 14:
Remarks 15:
Remarks 16:
Remarks 17:
Remarks 18:
Remarks 19:
Date Signed:
Contract Period or Dates of Performance Provided by Offeror:
Year or Total:
To Respondent:

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