Attachment_4_-_Past_Performance_Questionnaire_Simplified.doc

Attachment 4

Attachment 4

* PAST PERFORMANCE QUESTIONNAIRE

11 Mar 2014

MEMORANDUM FOR WHOM IT MAY CONCERN

FROM: 20th CONS/LGCAA

321 Cullen St.

SHAW AFB SC 29152-5105

Subject: Request for Performance Information, Solicitation # FA4803-14-R-0005, Redhorse Asphalt

1. One of the integral considerations in proposal evaluations is the verification of the offeror’s past performance on contracts, which reflect the offeror’s ability to perform on the proposed effort. This effort, solicitation number FA4803-14-R-0004 is for Redhorse Asphalt for Shaw AFB, SC. We depend upon information received from agencies such as yours, which have had first hand experience with the offeror, for the evaluation of their performance. Therefore, we request that the attached questionnaire be completed concerning the offeror’s present/past performance.

2. Our areas of interest are summarized in the enclosed questionnaire. You are urged to submit your comments on similar programs for which your activity has contracts or administers contracts with the offeror. Any additional information that you think would benefit Shaw AFB, SC in our evaluation of the offeror’s proposals would be appreciated. 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 offeror was required to provide points of conact for each reference provided to the Government, and the individual’s name completitng the questionnaire will not be disclosed to the offeror.

3. Due to time constraints, it is important that the questionnaire be completed and returned by the date proposals are due to the following address:

20th CONS/LGCAA

Attn: Stephen Sullivan

321 Cullen St.

Shaw AFB SC 29152-5105

Mark documents “SOURCE SELECTION SENSITIVE/FOR OFFICIAL USE ONLY”

Completed questionnaires may be faxed to (803) 895-5339 or DSN 965-5339, or emailed to stephen.sullivan@shaw.af.mil

4. If additional information is required, please contact, A1C Stephen Sullivan at (803) 895-5108, TSgt Frankie Mahan (803) 895-5351 or Anne Baker at (803) 895-5392.

Penelope E. Johnson

Contracting Officer

PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION NUMBER: FA4803-14-R-0005

Redhorse Asphalt

1. Please complete this questionnaire. The following is an explanation of the evaluation codes: PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

LIMITED

Evaluator please complete the following for contracts performed for your agency:

A. Contractor: __________________________________________________________

B. Cage Code _____________________________________________________________

C. Subcontractor:_____________________________________________________________

D. Contract number: ____________________________________________________________

E. Total annual contract dollar amount: _____________________________________________

F. Period of Performance: From: ____________________ To:___________________________

Exercised Option Periods: ______________________________________________________

G. Description of services being performed: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. Did you receive the product you purchased from the contractor?

Narrative: _________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

2. Did you receive your product on time?

Narrative: _________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

3. Was the product within the specifications you had set forth?

Narrative: _________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

4. Have you had any issue with the contractor’s product since delivery?

Narrative: _________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

5. If you had any issues with your product, did the contractor resolve them in a timely manner?

Narrative: _________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________

6. If this is/was an Airforce contract, how well did the contractor comply with all USAF regulations?

Narrative: ____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________

7. Based on your judgment of the contractor’s performance, would you award the contractor another contract?

CONFIDENCE

LIMITED

CONFIDENCE

CONFIDENCE

Narrative: ____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________

RESPONDENT(S) TO QUESTIONNAIRE

A. Name(s):

B. Phone Number(s):

C. Position/Duty Title :

Name of reviewer (print) ;_______________________________________________

Location _____________________________________________________________

Telephone Number _____________________________________________________

*Note: Will be removed at time of award.

FA4803-14-R-0005 1