Past_Performance_Questionnaire_(Atch_2).docx

FA4809-12-R-0008

PAST PERFORMANCE QUESTIONNAIRE

The below-named contractor/offeror is being considered for award of a contract for Contractor-Operated Civil Engineer Supply Store (COCESS) at Seymour Johnson AFB, NC. A primary consideration in our selection process is the contractor’s history of performance of similar efforts. Please make every effort to be thorough in your answers/comments. Completed questionnaires can be returned via mail, fax or email to the following:

A. GENERAL INFORMATION

Offeror’s Name:_______________________________________________________________________________

Address:_______________________________________________________________________________

Telephone Number:________________________ Point of Contact:______________________________________

B. RESPONDENT INFORMATION

Name:_____________________________________ Title:_____________________________________________

Organization & Address:_________________________________________________________________________

Telephone: ___________________ FAX:__________________ Email:___________________________________

C. CONTRACT INFORMATION

Contract Title:_________________________________________________________________________________ Period of Performance:__________________________ Contract Number:_________________________________ Total contract value, including all modifications and options:____________________________________________ Annual contract expenditures:_____________________________________________________________________ Total occupied square footage of facilities supported:__________________________________________________ Number of separate and distinct commodities provided under contract:_____________________________________ Description of contract effort:_____________________________________________________________________

(Include whether the effort supported a multi craft facility maintenance operation providing building supplies, repair parts and system components to carpenters, electricians, heating, ventilation and air conditioning mechanics, plumbers, and entomologists)

D. PERFORMANCE INFORMATION

The Air Force will use your survey responses to determine the level of confidence, based on the offeror’s past performance record, concerning the offeror’s ability to successfully perform our requirement in accordance with the contract. Please assign the following performance level codes to each of the questioned areas listed below based on the contractor’s performance at your organization or installation. The confidence codes selected will indicate the performance in each area.

RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCE INFORMATION TO OFFEROR SUBMITTING A PROPOSAL FOR THIS SOLICITATION.

Please indicate your satisfaction with the contractor’s performance by circling the appropriate code using the scale provided to the right of each question. This scale is defined as follows:

Please provide detailed narrative comments to support your ratings. At a minimum, please discuss each response for which you indicated US (Unsatisfactory) in response to the questions below (use additional sheets, if necessary) and any performance problems, the contractor’s solutions, and if the solution resolved the problem.

E. PERFORMANCE EVALUATION AREAS

Please use the above ratings and their assigned definitions to describe the offeror’s performance in the following areas:

COMMENTS/REMARKS_____________________________________________________________________

1. If a government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices?_____________ If yes, please describe:

2. If given the opportunity, would you award another contract to this contractor?_______

Please explain response below:

3. How would you rate the contractor’s overall performance: S (Satisfactory) US (Unsatisfactory)

Signature of Respondent___________________________________ Date____________

Job Title:________________________________________________________________

Thank you for taking the time to complete this questionnaire.

LEGEND OF TERMS

OFFEROR: The contractor for which past performance is being evaluated

SOLICITATION NUMBER: The procurement document number the government uses to identify a specific Request for Proposal (RFP)

RESPONDENT: The person and/or organization evaluating past performance

CONTRACT NUMBER: If the offeror had a contract or purchase order with your company/firm, the identifying contract number associated with awarded contract/purchase order

CONTRACT TITLE: Project title of work performed

CONTRACT VALUE: Contract/purchase order total dollar value, including all modifications and options

BRIEF DESCRIPTION OF WORK: Describe type of work being performed, to include whether the effort supported a multi craft facility maintenance operation providing building supplies, repair parts and system components to carpenters, electricians, heating, ventilation and air conditioning mechanics, plumbers, and entomologists.

Attachment 2