ATTACH_4_-_Past_ _Present_Performance_Questionnaire.doc

FA4621-14-R-0003

Attachment 4 DPM Packing and Crating Services Past and Present Performance Questionnaire McConnell AFB Kansas 4 September 2014

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Reference: FA4621-14-R-0003, DPM Packing and Crating 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 DPM Packing and Crating 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) 759-4515.

//SIGNED//

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:

Lisa Murrell, at lisa.murrell@us.af.mil and SSgt Marcus Tuckers, at marcus.tucker.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”.

CONTRACTOR’S NAME: _____________________________

CONTRACT NUMBER: _______________________________

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

16.

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

YES / NO

YES / NO

YES / NO

YES / NO

YES / NO

WORK PERFORMANCE QUESTIONS:

1. Did the Contractor have a local warehouse? _____________________________________

2. How was the Contractor’s performance on packing and crating services? ______________

3. Did the contractor perform a premove survey prior to performing the service? If so, was a written estimate completed prior? ________________________________________________

4. Was an inventory of the items conducted and documented?__________________________

5. Did the contractor weigh each shipment?_________________________________________

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

7. Did the Contractor receive any successful claims? If so, how many during this current contract period? ________________________________________________________________

REMARKS: ________________________________________________________________

Signature of Reviewer

Date