RFP,_Attch_9,_PP_Questionnaire.docx

Past and Present Performance Questionnaire 28 June 2017

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Base Custodial Services contract at Moody AFB, GA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at ________________________________.

Please submit completed questionnaire to the Government Contract Specialist identified on the attached questionnaire.

Contractor Signature

1 Attachment:

Past and Present Performance Questionnaire

I. GENERAL INFORMATION:

To Be Completed by the Contractor

A. Offeror Information:

Name (Company/Division):

CAGE Code: DUNS Number:

If Other than the Prime Offeror, Identify Prime Offeror:

B. Program Title:

C. Contract Specifics:

Contracting Agency or Customer:

Contract Number:

Contract Type: ______ Firm Fixed Price (FFP) Contract, ______FFP Task Order or Purchase Order, _____ Cost Reimbursable or Other Contractual Arrangement Period of Performance (include options):

Contract Dollar Value:

Has the contract been entered into the Contractor Performance Assessment Reporting System (CPARS)?

Yes or No Contract Environment: _______ Performance on an Air Force or Air Force Reserve Base, ____Performance on a DoD Installation within the United States _____ Performance at a Federal, State, County or City facility within the United States, ____ Other Performance Location.

D. Description of Contract as ___________ Prime or __________Subcontractor Indicate the type of services provided and highlight portions considered most relevant to the Base Custodial acquisition.

E. Size of Specialized Cleaning Facilities: Size of Child Development Center_____ SF, Size of Youth/School Age Center ____ SF, Size of Gymnasium____ SF

F. Number of building cleaned on a weekly basis: ____ NOTE! Buildings may only be counted once, even if they may be cleaned more than once on a weekly basis. For example, if building 595 is cleaned 3 times a week, it would still only be counted as 1 building.

II. RESPONDENT INFORMATION:

To Be Completed/Accomplished By the Respondent

Name of Respondent: _____________________ Title: ______________________ Address: ___________________________________________________________ Telephone Number: __________________________________________________ Fax Number: ________________________________________________________ Email Address: ______________________________________________________

Is the information provided by the Contractor in Section I, General Information accurate? ______ Yes ______No If not explain which information is not accurate:

C. SEND COMPLETED SURVEY FORM TO ALL THE EMAIL ADDRESS BELOW:

To Be Completed/Accomplished By the Respondent

kelli.gibbs.2@us.af.mil samantha.hampton@us.af.mil 23CONS.LGCB@us.af.mil

III. PERFORMANCE INFORMATION:

To Be Completed/Accomplished By the Respondent

Choose the appropriate letter on the scale (E, G, S, M, U, N) that most accurately describes the contractor’s performance or situation or N/A if performance in this area is not applicable to the effort addressed.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Performance meets contractual requirements and exceeded many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT #: _______________

Place an “X” in the appropriate column using the definitions matrix above.

Remarks (provide detail regarding unfavorable ratings, especially those concerning performance at child development centers and youth centers and fitness centers):