Atch_4_-_Past_Performance_Questionnaire.pdf

Attachment 4

PAST PERFORMANCE QUESTIONNAIRE

Oil/Water Separator Maintenance Services McConnell AFB Kansas

FA4621-19-Q-A008

PAST PERFORMANCE QUESTIONNAIRE AND COVER LETTER

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive 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 a Oil/Water Separator Maintenance Service contract at McConnell AFB, KS.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at (316) 759-4525.

X

CHRISTIAN T. ATES

Contracting Officer

1 Atch Past and Present Performance Questionnaire

Oil/Water Separator Maintenance Services McConnell AFB Kansas

FA4621-19-Q-A008

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: _________________________ 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 5 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: ______________________________________________________________________________

Address: ____________________________________________________________________________

Telephone Number:__________________________ Fax Number: ____________________________

Email Address: ______________________________________________________________________

C. EMAIL COMPLETED SURVEY FORM TO THE GOVERNMENT:

Send copies of completed surveys directly to the Government at the following email addresses:

daniel.mittuch.3@us.af.mil christian.ates@us.af.mil If there are any questions or comments, please contact 1Lt Daniel Mittuch at 316-759-4514 or by email at daniel.mittuch.3@us.af.mil.

D. 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

Performance meets/met contractual

Performance meets/met contractual

Performance does not meet/did not

Performance does not meet/did not meet most

Performance was not observed or mailto:christian.ates@us.af.mil mailto:cameron.collins.2@us.af.mil

Oil/Water Separator Maintenance Services McConnell AFB Kansas

FA4621-19-Q-A008

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.

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.

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

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.

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.

not applicable to the current effort being reported against.

CONTRACTOR’S NAME: ________________________ CONTRACT N0. _____________________

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

The contractor: E G S M UC

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

2. Home office participated in solving significant local problems.

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

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

5. Complied with all USAF regulations.

6. Corrected deficiencies in 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.

Oil/Water Separator Maintenance Services McConnell AFB Kansas

FA4621-19-Q-A008

10. Met established contract schedules.

11. Was responsive to contract changes.

12. Provided adequate project supervision.

13. Cooperated with Government personnel after award.

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

15. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” YES/NO

16. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

17. Is this contract rated in CPARS? YES/NO

Remarks:_____________________________________________________________________________________________

Oil/Water Separator Maintenance Services McConnell AFB Kansas

FA4621-19-Q-A008

Signature of Reviewer Date