Attachment 10 - Past Performance Questionnaire - Replace Well no.9.pdf
PDF 582 KB Posted
- Attached to
- Replace Utility Well #9 Beale AFB Federal contract opportunity
- Solicitation number
- FA468624R0006
About this file
This document contains a past performance questionnaire for federal contractors bidding on a solicitation to replace a utility well. The opportunity involves designing, drilling, installing, developing, equipping, testing and commissioning a replacement well to connect to existing electrical, communications and piping infrastructure at Beale Air Force Base. The questionnaire collects information about a contractor's relevant past experience including contract details like type, period of performance, pricing and description of services. Respondents are asked to provide customer and evaluator references along with signatures to validate responses. Relevant details include the soliciting agency of the Air Force Air Combat Command and response due dates listed in the related solicitation for replacing Well #9 at Beale AFB.
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Text version
ATTACHMENT - INSTRUCTIONS TO OFFERORS (ITO)
ITO – 1.2 Page 1
Replace Well No.9 Past Performance Questionnaire Project 1 of 2
WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104
SECTION 1: CONTRACT IDENTIFICATION
Contractor: _________________________________
Cage Code of contractor contract was awarded to: _________________________________
Contract number: _______________________________________
Contract type: ______________________________ (If multiple types (i.e. Firm-Fixed Price with Time & Material), list percentage and dollar amount of Firm-Fixed Price portion)
Was this a competitive contract? Yes _____ No _____
Did this contract include Design-Build efforts ? Yes _____ No _____
Did this contract include Bonding ? Yes _____ No _____
Period of performance: _________________________________________________________
Initial contract price: $____________________________
Current/final contract price: $_______________________________
Reasons for differences between initial contract price and final contract price:
Description of service provided:
ITO – 1.2 Page 2
SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION
Customer or agency name:
Customer or agency description (if applicable):
Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:
SECTION 3. EVALUATOR IDENTIFICATION
Evaluator's name:
Evaluator's title:
Evaluator's phone/fax number:______________________________________________________ Evaluator’s email: __________________________________________________________________
Number of years evaluator worked on subject contract: ___________________________________
ITO – 1.2 Page 3
Replace Well no.9 Past Performance Questionnaire Project 2 of 2
WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104
SECTION 1: CONTRACT IDENTIFICATION
Contractor: _________________________________
Cage Code of contractor contract was awarded to: _________________________________
Contract number: _______________________________________
Contract type: ______________________________ (If multiple types (i.e. Firm-Fixed Price with Time & Material), list percentage and dollar amount of Firm-Fixed Price portion)
Was this a competitive contract? Yes _____ No _____
Did this contract include Design-Build efforts ? Yes _____ No _____
Did this contract include Bonding ? Yes _____ No _____
Period of performance: _________________________________________________________
Initial contract price: $____________________________
Current/final contract price: $_______________________________
Reasons for differences between initial contract price and final contract price:
Description of service provided:
ITO – 1.2 Page 4
SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION
Customer or agency name:
Customer or agency description (if applicable):
Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:
SECTION 3. EVALUATOR IDENTIFICATION
Evaluator's name:
Evaluator's title:
Evaluator's phone/fax number:______________________________________________________ Evaluator’s email: __________________________________________________________________
Number of years evaluator worked on subject contract: ___________________________________
ITO – 1.2 FA4686-16-R-0007 Page 5
Evaluator’s Signature Date__________________________
Thank you for your prompt response and assistance!
Please return this completed questionnaire to:
DEPARTMENT OF THE AIR FORCE
gene.yu.1@@us.af.mil and gabriel.fickel@us.af.mil mailto:Kelly.Benton@us.af.mil mailto:Dustin.Lashley@us.af.mil
ITO ATTACHMENT 1.2
File details come from the government source that posted it. Updated .