Attachment_2_Questionnaire.pdf

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 36TH WING (PACAF)

ANDERSEN AIR FORCE BASE GUAM

1 August 2017

MEMORANDUM FOR ALL INTERESTED PARTIES

FROM: 36 CONS/LGCB

Bldg. 22026 Unit 14040 Andersen AFB, Yigo, GU 96929

The 36th Contracting Squadron at Andersen AFB is in the process of competitively selecting a source for furniture on Andersen AFB.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than 10 calendar days after your receipt of this letter. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to jared.terrill@us.af.mil. Please call Niki Brown at 671-366-1718 if you have any questions. Your completed questionnaire will become a part of the official records.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this selection.

NIKI J. BROWN

Contracting Officer mailto:jared.terrill@us.af.mil

Under the Privacy Act of 1974, you must safeguard all information, if required, reflected on this document and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 33-129, DoD 5400. 7-R/Air Force Supplement

(Freedom of Information Act), AFI 33-332 (Privacy Act), AFI 33-219, and PL 93-579.

Section 1: Contract Identif ication

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Period of Performance:

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Description of work performed:

J. Was this a competitively awarded contract? ☐ Yes ☐ No

K. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of items/services under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identif ication

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

Under the Privacy Act of 1974, you must safeguard all information, if required, reflected on this document and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 33-129, DoD 5400. 7-R/Air Force Supplement

(Freedom of Information Act), AFI 33-332 (Privacy Act), AFI 33-219, and PL 93-579.

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Section 4: Performance Information

In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Note: The following are SAMPLE questions. Past Performance evaluation teams MUST construct a simple and concise Past Performance Questionnaire, tailored to seek out key information tied to the significant aspects of the planned acquisition. Avoid questions that can be answered with a “yes” or “no” but instead include probing and direct questions to draw out the required information desired.

E Exceptional

G Good

S Satisfactory

M Marginal

U Unsatisfactory

N Neutral

Under the Privacy Act of 1974, you must safeguard all information, if required, reflected on this document and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 33-129, DoD 5400. 7-R/Air Force Supplement

(Freedom of Information Act), AFI 33-332 (Privacy Act), AFI 33-219, and PL 93-579.

A. QUALITY AND TIMELINESS OF SERVICE

1. Contractor provided quality furniture.

E G S M U N

2. Delivery of furniture was on time, if delivery was late it was caused by excusable delays.

E G S M U N

3. Installation of furniture was done in accordance with the contract.

E G S M U N

SUPPORTING INFORMATION:

Please provide the following information regarding cost/price:

(1) Original Contract Cost/Price $

(2) Final Contract Cost/Price $

REMARKS:

B. Government Contracts Only: Was this contract 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).

C. Overall Quality Rating: What is your overall satisfaction with the contractors ability to provide satisfactory furniture and installation?

☐ E ☐ V ☐ S ☐ M ☐ U ☐ N/A

REMARKS:

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: jared.terrill@us.af.mil mailto:jared.terrill@us.af.mil

A. QUALITY AND TIMELINESS OF SERVICE