Attachment 07 Past Performance Questionnaire Rev 01.pdf

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Attached to
B11177 HVAC Replacement
Solicitation number
FA468624R0027
Issued by

About this file

This document is a Past Performance Questionnaire that is part of the solicitation for the B11177 Remove/Replace Tool Crib HVAC Project at Beale AFB, CA. The questionnaire requests information on the contractor's previous contract, including the contract number, type, period of performance, initial and final contract price, description of services provided, and customer/agency details. The respondent is asked to provide an evaluator's contact information as well. This questionnaire is considered source selection sensitive information.

The related federal contract opportunity is for the B11177 HVAC Replacement project at Beale AFB, CA. The solicitation has a range of magnitude between $250,000 and $500,000, with a NAICS code of 238220 and a size standard of $19,000,000. The project is set aside for small businesses, with proposals due on 3 Sept 2024. A site visit is scheduled for 13 Aug 2024, and contractors must complete access paperwork by 20 Jun 2024 to attend. The work must be completed within 180 calendar days, not including weather delays.

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ATTACHMENT - INSTRUCTIONS TO OFFERORS (ITO)

ITO 1.2 Page 1

B11177 Remove Replace Tool Crib HVAC 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:

1161645342C Cross-Out

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 .