FA5000-16-R-0025 _Attachment_3_-_PPQ.pdf

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 5).

CONTRACTOR COMPANY NAME: ADDRESS: CAGE CODE:

DUNS NUMBER:

POINT OF CONTACT: TELEPHONE NUMBER: FAX NUMBER:

CONTRACT NUMBER: CONTRACT TITLE:

SECTION B - RESPONDENT INFORMATION: To be completed by each reference providing information in Sections C, D, & E. This is a 3-page questionnaire---please complete all 3 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:

Jesse Hastings - jesse.hastings@us.af.mil Nicole Jordan - nicole.jordan.3@us.af.mil

MAILING ADDRESS:

673 CONS/LGCB

10480 Sijan Ave, Ste 240

JBER AK 99506

TELEPHONE

NUMBERS:

VOICE: (907) 552-5870

552-6769

COMPLETE & RETURN PRIOR TO 11 July 2016, 12:00 P.M.

Alaska Daylight Standard Time (ADST)

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

Number of Classes Taught:

REASON FOR DIFFERENCE BETWEEN INITIAL AND CURRENT/FINAL CONTRACT COSTS:

FOUO Source Selection Sensitive Upon Completion – See FAR 2.101 and 3.104

FA5000-16-R-0025, Aerobics Instructors Attachment 3, Past Performance Questionnaire (PPQ) mailto:dan.cross.2@us.af.mil

SECTION D – PERFORMANCE INFORMATION: To be completed by each reference.

Yes No

1. Does your contract require a wide range of Aerobics classes (ex. Zumba, TRX, Cycling, Water Aerobics)?

2. Does your contract require instructor certification and first aid certification prior to performance?

3. Does a contract or combination of contracts involve instructing 1,000 or more Aerobics classes annually?

SECTION E - QUALITY ASSESSMENT RATINGS: To be completed by each reference.

RATING DEFINITION

S Satisfactory During the contract period, contractor performance is meeting (or met) contract requirements. For any problems encountered, contractor took effective corrective action.

U Unsatisfactory During the contract period, contractor performance is not meeting (or did not meet) contract requirements. For any problems encountered, corrective action appeared only marginally effective, not effective, or not fully implemented.

Customer involvement was required.

N/A Not Applicable Used if the rating(s) are not going to be applied to a particular area for evaluation.

QUALITY OF SERVICE S U N/A

4. How would you rate the contractor's ability to consistently instruct and manage the workload associated with the standards outlined in your Performance Work Statement, Statement of Work, or equivalent requirements document?

5. How well did the Contractor respond to any cancellations or instructor tardiness?

6. How would you rate the contractor's responsiveness and timeliness in submitting deliverables and administrative documents such as rosters, certificates, monthly and/or quarterly schedules, sign in sheets, and class attendance rosters?

MANAGEMENT

7. How would you rate the contractor's overall effectiveness in managing the contract including environmental, safety health and security requirements?

8. How would you rate the contractor’s ability to effectively manage subcontractors?

OVERALL ASSESSMENT

9. What is your overall assessment of this past performance for this contractor?

10. Would you hire this contractor again? If not, please explain.

Evaluator's Signature Date

FOUO Source Selection Sensitive Upon Completion – See FAR 2.101 and 3.104

FA5000-16-R-0025, Aerobics Instructors Attachment 3, Past Performance Questionnaire (PPQ)

Source Selection Sensitive Upon Completion – See FAR 2.101 and 3.104