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FA4690-16-R-0001
Attachment 6
PAST PERFORMANCE INFORMATION FORM
The 28th Contracting Squadron, Ellsworth AFB, South Dakota, is in the process of selecting a contractor for a Grounds Maintenance and Snow Removal contract. One of the considerations in proposal evaluation is the verification of the Offeror’s past and present performance on contracts, which reflect the Offeror’s ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had firsthand experience with an Offeror, for the evaluation of the Offeror’s performance on those contracts.
Please complete this form and providing comments wherever applicable. Please sign the document in the space provided. Please note we may contact the Offeror on problem areas or concerns identified to see what corrective actions have been taken or will be taken. However, the individual’s name completing the questionnaire will not be disclosed to the Offeror.
Please email the completed form as soon as possible but no later than the offer due date noted in the Solicitation. Please obtain this date from your contractor. DO NOT RETURN OR EMAIL THE COMPLETED QUESTIONNAIRE BACK TO THE CONTRACTOR. Forms submitted directly from the Contractor being evaluated will be thrown out. Email completed form directly to jeffery.porter.1@us.af.mil and cc: steven.gustaf@us.af.mil. Your help and prompt response are greatly appreciated.
When filled in this document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104
A. GENERAL INFORMATION:
Contractor’s Name: _______________________ Telephone Number: __________________ Address: ________________________________ Point of Contact : ____________________
Email: _____________________________
CAGE Code: ____________________________ DUNS Number: ______________________
Contract Number:_______________________
Dollar Amount: _______________________* Contract Type: ___________________________ Date of Award: _______________________
Contract Period or Dates of Performance Provided by Offeror: _______________________________*
Project Title and Brief Description of Work or Services performed:___________________________*
Contractor performed as the Prime Contractor Sub-Contractor
*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.
B. RESPONDENT INFORMATION:
Name of Respondent: ______________________________ Title: ____________________________ Address: ________________________________ Telephone Number: ___________________
Email Address: _______________________ C. EMAIL COMPLETED SURVEY FORM TO: david.king.34@us.af.mil; cc: steven.gustaf@us.af.mil D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (A, U and UNK) that most accurately describes the contractor’s performance or situation. Please provide an explanation for any ratings of U.
| Acceptable (A) |
| Based on the offeror's performance record, the Air Force has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror's performance record is unknown. |
| Unacceptable (U) |
| Based on the offeror's performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort. |
| Unknown (UNK) |
| In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so spars that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the offeror shall be determined to have unknown past performance. |
CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER: ________________
Place an “X” in the appropriate column using the definitions matrix above. Explain the circumstances of any “unsatisfactory” rating or general comments in the “Remarks” area of each item.
| 1 |
| Rate how well the contractor provided adequate, competent and qualified personnel capable of meeting contract requirements throughout the performance period of the contract. |
Remarks:
| 2 |
| Rate how well the contractor perform(s/ed) the terms of the contract within the contractually agreed price. |
| 3 |
| Rate how timely and sufficient the contractor’s resources (manning levels, etc.) were/are to meet contract requirements (technical, management, and contractual). |
Remark:
| 4 |
| Rate how well the contractor respond(s/ed) to and act(s/ed) on customer feedback. |
| 5 |
| Rate how well the contractor demonstrate(s/d) a reasonable and cooperative business relationship with the Government’s Program Management and Contract Management teams. |
| 6 |
| Rate the effectiveness of the contractor’s security and safety program to ensure compliance with federal, state and local regulations. |
| 7 |
| Rate how timely and effective the contractor’s responses to and resolution of problems were/are. |
| 8 |
| Rate how flexible, cooperative, and reasonable the contractor was/is in meeting mission requirements, particularly during short-notice mission changes. |
| 9 |
| Rate how responsive the contractor’s quality program was/is in identifying, correcting, and preventing initial and recurring contract discrepancies. |
| 10 |
| Was the contractor ever issued a cure or show cause notice, or was the contract terminated? If yes, please explain. |
| 11 |
| Is the contract rated in CPARS? |
| 12 |
| Would you award another contract to this contractor? If not, please explain. |
SOURCE SELECTION SENSITIVE/FOR OFFICIAL USE ONLY