ATTACH_-_5 _Past_ _Present_Performance_Questionnaire.doc

FA4621-14-R-0001

Attachment 5 Hangar Door Maintenance Services Past and Present Performance Questionnaire McConnell AFB Kansas 3 September 2014

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Reference: FA4621-14-R-0001, Hangar Door Maintenance Services

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

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 Hangar Door Maintenance 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

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 _________________* ( Dollar value should include period of performance that applies to this contract, i.e 6-months, 1 year or 5 years)

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:

SSgt Quarteeya Garner, quarteeya.garner@us.af.mil and SSgt Daniel Parks, daniel.parks.2@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”.

CONTRACTOR’S NAME: _____________________________

CONTRACT NUMBER: _______________________________

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

17.

19.

20.

21.

YES / NO

WORK PERFORMANCE QUESTIONS:

1. Did the Contractor service electric and/or non-electric hangar doors? YES/NO If yes, how many doors and how often were they serviced? _____________________________________

2. Did the Contractor service rollup, coiling and/or overhead doors? YES/NO If yes, how many doors and how often were they serviced? __________________________________________

3. Has the Contractor worked on mega doors? YES/NO If yes, what types of mega doors and how often were they serviced? __________________________________________________

4. Has the Contractor performed any service on tail doors? YES/NO If yes, what types of tail doors and how often were they serviced? __________________________________________

5. Does your contract include monthly, quarterly, or yearly inspections? How were these inspections documented? ________________________________________________________

6. Has the Contractor worked on aluminum and/or steel doors? YES/NO If yes, how often and how often were these doors serviced? _______________________________________________

REMARKS: ________________________________________________________________

Signature of Reviewer

Date