Attachment 10 Past Performance Questionnaire - Backflow Preventer Replacement.pdf
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- Solicitation number
- FA468624R0022
About this file
This document is a Past Performance Questionnaire for a Backflow Preventer Replacement project. It requests information about a previous contract, including the contractor, contract number, type, and value, as well as a description of the services provided, the customer agency, and the evaluator's contact information.
The related federal contract opportunity is for a Backflow Preventer Replacement project at Beale Air Force Base. The solicitation number is FA468624R0022, and the contract value is estimated between $100,000 and $250,000. The project must be completed within 60 calendar days, and a site visit is scheduled for June 27, 2024. Proposals are due by July 15, 2024. The contract is set aside for small businesses under NAICS code 237110.
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ATTACHMENT - INSTRUCTIONS TO OFFERORS (ITO)
ITO – 1.2 Page 1
Backflow Preventer Replacement 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
Backflow Preventer Replacement 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
robert.briney.2@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 .