Attachment 6 - Past Performance Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

Company:

Date:

Address:

1. We are contemplating offering a proposal for a solicitation from the 36th Contracting Squadron OBO the 36th Medical Group on Anderson Air Force Base, Guam. The solicitation is for Medical Materiel Technician Services. This proposal requires that we provide past performance information. Please complete the attached past performance questionnaire and return it via email to: crystal.pryde.1@us.af.mil and elena.gifford.1@us.af.mil.

2. In order to ensure this questionnaire is considered, please forward this survey to arrive at the above email address, no later than 18 September 2025. Upon completion, please notify my office that the survey has been accomplished.

Name & Title of Individual Name of Company

1 Attachment: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: __________________ Telephone Number: ____________________ Address: __________________________ __________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: _____________________________________

Contract Number: ___________________ Overall Contract Value: ________

Contract Period or Dates of Performance: _______________________

Contractor performed as the Prime Contractor Sub-Contractor

B. POINT OF CONTACT INFORMATION:

Your Name: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Email Address: _____________________

C. RETURN COMPLETED QUESTIONNAIRE VIA EMAIL TO:

Ms. Crystal Pryde at crystal.pryde.1@us.af.mil Ms. Elena Gifford at elena.gifford.1@us.af.mil

CONTRACTOR PERFORMANCE EVALUATION SURVEY

For each of the five criteria listed below, the rater must choose One (1) Adjectival Rating by checking the box, as applicable. At a minimum, for any rating that is checked Marginal or Unsatisfactory, please submit additional comments to substantiate the rating.

Rater: Please submit completed form to crystal.pryde.1@us.af.mil and elena.gifford.1@us.af.mil.

In the subject line, please include “PP ‘Contractor Name’”.

mailto:crystal.pryde.1@us.af.mil mailto:elena.gifford.1@us.af.mil

1. QUALITY OF SERVICE

RATING Adjectival Rating

Definition

Exceptional

Performance meets contractual requirements and exceeds many to the Government’s benefit.

The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Very Good

Performance meets contractual requirements and exceeds some to the Government’s benefit.

The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Satisfactory

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Marginal

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Unsatisfactory

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

ADDITIONAL COMMENTS:

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2. SCHEDULE

3. COST CONTROL

Not Applicable

4. BUSINESS RELATIONS

5. MANAGEMENT OF KEY PERSONNEL