Attachment_4_-_Past_Performance_Questionnaire.pdf

10 June 2013 Attachment 4

FA4855-13-R-0017

PAST/PRESENT PERFORMANCE QUESTIONNAIRE (PPQ)

WHEN FILLED-IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

SECTION A: Contractor Information (to be completed by the offeror prior to mailing to the reference):

A. Contractor’s name and address: _____________________________________________________________

B. Point of Contact: _______________________________________________________

C. Phone/Fax/Email Address: _______________________________________________

D. Contract Number: ______________________________________________________

E. Description of work or items provided: ___________________________________________________________

F. Contract Type: Firm-Fixed Price Indefinite-Delivery/Indefinite-Quantity Cost-Reimbursement

G. Project Award Date: _________________________ Scheduled Completion Date ______________

Current/Final Completion Date ____________

H. Project Award Amount: _____________________ Current/Final Project Amount ____________________

I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier

J. Authorization is hereby granted to provided the information requested in SECTION B of this Questionnaire

(Name and Title of Authorizing Official) (Date)

(Signature)

SECTION B: To be completed by the Reference/Evaluator: Please complete the information below and the Past Performance Questionnaire on Pages 2 & 3, and return by fax, email, or mail to: Maria-Jaine A.

Sipin or A1C Alix Rosa, 27 SOCONS/CFLT, NO LATER THAN 30 SEPTEMBER 2013.

EVALUATED BY:

(Signature) (Date)

_____________________________________ Address: _______________________________________

(Typed or Printed Name)

(Title)

(Phone) (Fax) (/Email)

NOTE: The identity of individual(s) providing reference information SHALL NOT be disclosed.

URGENT! PLEASE RESPOND PROMPTLY

Past Performance Questionnaire

E VG S M U N

EXCEPTIONAL VERY GOOD SATISFACTORY MARGINAL UNSATISFACTORY NEUTRAL

Performance

EXCEEDS MOST

contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns.

Performance

EXCEEDS SOME

contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns, for which the Contractor’s corrective actions were highly effective.

Performance MEETS contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the Contractor were effective.

Performance MEETS SOME contractual requirements. The performance of the areas being assessed includes significant problems, issues, or concerns for which corrective actions taken by the Contractor were only somewhat effective.

Performance DOES NOT MEET contractual requirement. The performance of the areas being assessed includes serious problems, issues, or concerns for which the Contractor’s corrective actions were ineffective.

Performance information not recent or relevant as defined in the Solicitation. Unable to provide assessment.

I. Performance: What is your assessment of the Contractor’s ability to meet your requirements?

I. Performance E VG S M U N

1. Contractor’s ability to meet the requirement

Comments, if any:

II. Timeliness: What is your assessment of the Contractor’s ability to provide products in a timely manner?

II. Timeliness E VG S M U N

1. Timeliness

2. Ability to Resolve Timeliness Problems

III. Quality of Shipments: What is your assessment of the Contractor’s ability to meet requirements of shipping (including packing, marking, etc) and the overall quality of the delivery?

III. Quality of Shipments E VG S M U N

1. Quality of Shipments

IV. Overall Performance E VG S M U N

1. Please rate the contractor’s overall performance

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___

No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

NARRATIVE SUMMARY:

What were the contractor’s most positive aspects in the performance of the contract?

What were the contractor’s most negative aspects in the performance of the contract?

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Thank you for your prompt response and assistance!

Evaluator’s Signature Date

Please return this completed questionnaire no later than 30 September 2013 to:

Maria Jaine A. Sipin A1C Alix Rosa th

SOCONS/AFLT 27

th

SOCONS/CFLT

110 E. Alison Ave, Bldg 600 110 E. Alison Ave, Bldg 600

Cannon AFB, NM 88103-5214 Cannon AFB, NM 88103-5214

E-mail: maria-jaine.sipin@cannon.af.mil E-Mail: alix.rosa@cannon.af.mil

Fax: 575-784-1148