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Attachment 6 Solicitation: FA4690-19-R-0001
DEPARTMENT OF THE AIR FORCE
28TH CONTRACTING SQUADRON (AFGSC)
ELLSWORTH AIR FORCE BASE SOUTH DAKOTA
PAST PERFORMANCE QUESTIONNAIRE
1. 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: Bernard.clemens@us.af.mil and kathleen.green@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 Government 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 does not have a 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. |
YES
(remarks below)
NO
| 11 |
| Would you award another contract to this contractor? If not, please explain. |
E-Mail to: bernard.clemens@us.af.mil kathleen.green@us.af.mil
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