Atch 3 Past Performance Questionnaire.pdf

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

FA462525Q1068, Attachment #4

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The 509th Contracting Squadron of the Air Force Global Strike Command is in the process of competitively selecting a source for Fitness Instructor services on Whiteman AFB. Fitness Instructor classes will be performed in a group setting offering various types of exercise instruction.

One of the considerations in proposal evaluation is the verification of the offerors’ past performance on contracts or other work efforts which reflect the offerors’ ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offerors’ performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than seven (7) calendar days after your receipt of this letter. This schedule will allow us sufficient time to analyze the data prior to the start of source selection.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to brevin.morris@us.af.mil and brittainy.shirley@us.af.mil Please call A1C Brevin Morris at 660-687-4291 or LT Brittainy Shirley at 660-687-5466 if you have any questions. Your completed questionnaire will become a part of the official source selection records.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Brittainy Shirley Contracting Officer

1 Attachment Past Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836 mailto:brevin.morris@us.af.mil mailto:brittainy.shirley@us.af.mil

FA462525Q1068, Attachment #4

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Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contract Number:

C. Contract Type (e.g., fixed price, cost reimbursable, etc.):

D. Project Title:

E. Brief Project Description:

Type project description here.

F. Period of Performance

1. Original Completion Date: Click or tap to enter a date.

2. Actual Completion Date: Click or tap to enter a date.

3. Reason for difference (if applicable): Click or tap to enter a date.

G. Contract Dollar Value

1. Original contract dollar value: $

2. Actual contract dollar value: $

3. Reasons for difference (if applicable):

H. Description of work performed:

Type description of work here.

I. Was this a competitively awarded contract? ☐Yes ☐ No J. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

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C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

Section 4: Performance Information

In the table below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

FA462525Q1068, Attachment #4

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The Contractor: E V S M U N A

1. Developed and maintained a cooperative and productive professional working relationship through all phases of the contract.

Comments:

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

3. Kept/Provided a full and comprehensive record of all required actions, as required by the terms of the contract.

4. Demonstrated the ability to complete work in a safe and timely manner.

5. Promptly, identified problems, hazardous material, or other site issues to the Agency.

6. Maintained adequate oversight of subcontractor personnel and of work performed.

7. Corrected deficiencies in timely manner and corrective action was effective.

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The Contractor: E V S M U N A

8. Worked diligently to complete the effort with no site abandonment exceeding five (5) working days.

9. Paid all employees, subcontractors, and suppliers as required by the terms of the contract.

10. Discarded all waste or hazardous material in accordance with state, federal, local, and environmental procedures/regulations.

11. Provided and used the proper personal protective equipment (PPE) for all work in accordance with OSHA regulations.

12. Provided and used the proper personal protective equipment (PPE) for all abatement work in accordance with OSHA, EPA, and other federal regulations.

13. Partnered with the Agency to find cost effective solutions to issues encountered during the course of work.

14. How would you rate the contractor’s overall performance on this contract?

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The Contractor: E V S M U N A

15. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain.

☐ Yes

☐ No

16. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

☐ Yes

☐ No

Additional remarks (these are important; please include comments):

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address:

A1C Brevin Morris 660 Tenth Street, Suite 222 Whiteman AFB MO 65305

E-Mail to: brevin.morris@us.af.mil and brittainy.shirley@us.af.mil http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836 mailto:brevin.morris@us.af.mil mailto:brittainy.shirley@us.af.mil