ATCH 3 Past Performance Questionnaire.doc

Solicitation: FA5000-10-R-0004

Attachment 3

PAST AND PRESENT PREFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE IN ACCORDANCE WITH FEDERAL ACQUISITION REGULATIONS PARTS 2.101 AND 3.104

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 ____________________________. This firm is currently being considered for a contract at Elmendorf AFB, Alaska.

Please complete the attached questionnaire and send to:

3rd Contracting Squadron/LGCB

ATTN: Jason Williams and Annette Wilson 10480 22nd Street, Suite 369 Elmendorf AFB, AK 99506-2500 Email: Jason.Williams@elmendorf.af.mil and Annette.Wilson@elmendorf.af.mil Your prompt attention to this questionnaire will be greatly appreciated. Please direct questions to the above e-mail addresses or phone Jason Williams @ 907-552-4268 and/or Annette Wilson @ 907-552-8116.

Enclosure

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SECTION 1: GENERAL INFORMATION

COMPANY NAME: ___________________________________________________________________________ ADDRESS: __________________________________________________________________________________

COMPANY POINT OF CONTACT: ______________________________________________________________

PHONE NUMBER: ____________________________________________________________________________

SECTION 2: REFRENCE INFORMATION

COMPANY/INDIVIDUAL NAME: _______________________________________________________________

COMPANY POINT OF CONTACT: _______________________________________________________________

PHONE NUMBER: ____________________________________________________________________________

PERIOD OF PREFORMANCE FOR SERVICES: FROM ________________ THROUH ___________________

DESCRIPTION OF SERVICES PROVIDED: _______________________________________________________

SECTION 3: COMPANY EVALUATION

PREFORMANCE INFORMATION: Choose a number on a scale of 1 to 6 that most accurately describes the contractor’s performance. Please provide comments in which an Unsatisfactory or Exceptional Rating is given and as appropriate for all other answers. Space for your comments is provided in each area. If more space is needed, additional space is provided at the end of the survey or attach additional sheets to the end of the questionnaire and reference the respective question.

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

2 – Unsatisfactory. 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) with the contractor’s corrective actions appear or were ineffective.

3 - Marginal. 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 proposed actions appear only marginally effective or were not fully implemented.

4 - Satisfactory. Performance meets contract requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

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

6 - Exceptional. Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with nor more than a few minor problems for which corrective actions taken by the contractor were highly effective.

EVALUATION:

1. Overall, how would you rate their services?

Comments: ________________________________________________________________________________

2. Quality of work performed?

Comments: ________________________________________________________________________________

3. Quality of food or beverages served?

Comments: ________________________________________________________________________________

4. Promptness or timeliness of the services provided?

Comments: ________________________________________________________________________________

5. Appearance and cleanliness of the facilities?

Comments: ________________________________________________________________________________

6. Courtesy and attitude of staff?

Comments: ________________________________________________________________________________

7. Ability to meet established schedules or set deadlines? 1

Comments: ________________________________________________________________________________

8. Hours of operation meet customers’ needs?

Comments: ________________________________________________________________________________

9. Provided timely resolution of customer complaints?

Comments: ________________________________________________________________________________

10. Displayed imitative to solve problems or made suggestions for alternative approaches to problems?

Comments: ________________________________________________________________________________

11. Ability to effectively communicate with others?

Comments: ________________________________________________________________________________

12. Professionalism of management?

Comments: ________________________________________________________________________________

13. Ability to comply with all applicable laws and regulations? 1

Comments: ________________________________________________________________________________

14. Was the contractor ever issued a cure or show cause notice for previous contractual work?

YES NO

If yes, explain outcome below.

Comments: ________________________________________________________________________________

15. Would you award another contract or work to the contractor?

YES

NO

If yes, explain below.

Comments: ________________________________________________________________________________

ADDITIONAL COMMENTS: ____________________________________________________________________