Atch 7 Past Present Perf Questionnaire.pdf

Solicitation No. FA4855-10-R-0002 Attachment 7

Solicitation No. FA4855-10-R-0002 FOR OFFICIAL USE ONLY Attachment 7 (When filled in, this document contains Source Selection Sensitive Information)

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SECTION A - CONTRACTOR INFORMATION: Offeror is to complete this section prior to sending this form to each reference listed on the Past and Present Performance References form (Attachment 6).

CONTRACTOR COMPANY NAME ADDRESS CAGE CODE:

DUNS NUMBER:

POINT OF CONTACT TELEPHONE NUMBER (to include area code) FAX NUMBER (to include area code)

CONTRACT NUMBER CONTRACT TITLE

SECTION B - RESPONDENT INFORMATION: To be completed by each reference providing information in Sections C

& E. This is a 4-page questionnaire---please complete all 4 pages.

TYPED/PRINTED NAME TITLE COMPANY/ORGANIZATION

ADDRESS (Street, City, State, and Zip Code)

TELEPHONE NUMBER (to include area code)

FAX NUMBER (to include area code)

E-MAIL ADDRESS SIGNATAURE DATE

RETURN COMPLETED QUESTIONNAIRE TO THE INDIVIDUAL LISTED BELOW:

POINT OF CONTACT AND E-MAIL ADDRESS:

Ms Margaret Merrell margaret.merrell@cannon.af.mil or Ms. Linda Kyle linda.kyle@cannon.af.mil

MAILING ADDRESS:

27 SOCONS/AFLT

110 E Sextant Ave, Bldg 600 Cannon AFB NM 88103-5214

TELEPHONE NUMBERS

VOICE: (575) 784-4305

(575) 784-2880

FAX: (575) 784-1147

COMPLETE & RETURN PRIOR TO

9 Apr 2010 @ 2:00 PM MST

SECTION C - CONTRACT SPECIFICS: To be completed by each reference. Some of this information is a repeat from

Section A and is requested only to confirm the information.

CONTRACT NUMBER CONTRACT TYPE (Firm-Fixed Price, Cost

Reimbursement, etc.)

PERIOD OF

PERFORMANCE

COMPETITIVE CONTRACT?

YES NO

INITIAL CONTRACT VALUE CURRENT/FINAL CONTRACT VALUE CONTRACT BEING EVALUATED AS (indicate which):

PRIME CONTRACTOR

SUBCONTRACTOR

CONTRACT TITLE

BRIEF DESCRIPTION OF SERVICES

REASON FOR DIFFERENCE BETWEEN INITIAL AND CURRENT/FINAL CONTRACT COSTS

mailto:margaret.merrell@cannon.af.mil mailto:linda.kyle@cannon.af.mil

Solicitation No. FA4855-10-R-0002 FOR OFFICIAL USE ONLY Attachment 7 (When filled in, this document contains Source Selection Sensitive Information)

Less Favorable More Favorable

U M N S VG E

Unsatisfactory Marginal Neutral Satisfactory Very Good Exceptional (Strongly Disagree)

(Wouldn't recommend) (Unsatisfactory)

(Below expectations) (Poor performer)

(Not Applicable: No past performance available)

(Agree) (Acceptable)

(would recommend)

(Highly Agree) (Strong

Performer)

(Strongly Agree) (Exceptional Performer)

CHECK ALL THAT APPLY TO CONTRACT:

Laundry Processing Services Packaging

Dry Cleaning Processing Services Repairs/Replacement

Pickup Services Proper Handling of Contaminated Laundry

Delivery Services

EVALUATION AREAS

1. CUSTOMER SATISFACTION:

a Customer would have no reservations in awarding another contract to the Contractor.

U M N S VG E

b Did the Contractor display the initiative to resolve problems? U M N S VG E

2. QUALITY:

a Contractor provided effective quality control and inspection procedures which resulted in a quality service to the Government?

U M N S VG E

b Contractor delivery of laundry is properly finished and packaged. U M N S VG E c Contractor delivery of laundry is free from dirt, contaminates, debris, dampness, offensive odors, mildew, cleansing chemicals residue.

U M N S VG E

d Contractor completed all work with good workmanship and in conformance with the specifications.

U M N S VG E

e Correct quantities of laundry are delivered. U M N S VG E f All unserviceable articles and non-repairable articles are returned in separately marked bundles.

U M N S VG E

g If work was re-performed, was it competed satisfactorily? U M N S VG E

3. RESPONSIVENESS:

a Contractor's responsiveness relative to performance/service schedules (pick-up/delivery).

U M N S VG E

b Contractor’s responsiveness relative to administrative reports/documents required by the contract.

U M N S VG E

c Contractor's responsiveness relative to settling customer complaints. U M N S VG E

4. TIMELINESS:

a Contractor submitted timely invoices and supporting paperwork to support scheduled payments, as required.

U M N S VG E

b Contractor provided timely resolution of all contract discrepancy items. U M N S VG E c Contractor provided timely response and cost proposals, as appropriate, for contract changes/modifications.

U M N S VG E

Solicitation No. FA4855-10-R-0002 FOR OFFICIAL USE ONLY Attachment 7 (When filled in, this document contains Source Selection Sensitive Information)

Questions:

1. Has the contractor demonstrated a positive safety record?

2. Has the contractor fulfilled all requirements of your Statement of Work, or similar document?

3. Have you ever had to point out performance deficiencies to the contractor?

If yes, has the contractor re-performed the service in a satisfactory manner?

4. Has the contractor provided you with all the required documentation?

Has the documentation been properly prepared?

5. Does the Contractor comply with JCAHO and OSHA standards?

Solicitation No. FA4855-10-R-0002 FOR OFFICIAL USE ONLY Attachment 7 (When filled in, this document contains Source Selection Sensitive Information)

6. Has the Contractor ever been issued a cure/show cause notice?

If yes, please explain below.

7. Was the contract terminated for default? If so, what was the reason?

8. Has the contractor demonstrated to you his/her willingness to work with you to solve problems?

9. Overall, how would you describe the contractor's performance as (circle one)?

a) Exceptional/High Confidence

b) Very Good/Significant Confidence

c) Satisfactory Confidence

d) Marginal/Little Confidence

e) Unsatisfactory/No Confidence

10. Would you recommend another municipality/organization use the same contractor based on your experience?

Solicitation No. FA4855-10-R-0002 FOR OFFICIAL USE ONLY Attachment 7 (When filled in, this document contains Source Selection Sensitive Information)

11. Did you choose to exercise option years of the contract?

If no, please explain why.

12. Please add any additional comments about the contractor and your experience working with him/her.