Attch_5_-_Past_and_Present_Performance_Questionnaire.pdf

Source Selection Information – See FAR 2.101 and 3.104

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

FOR

SOLICITATION NO. FA5270-16-R-0021

Pump Out & Clean Septic Tank Services, Okinawa, Japan

The U.S. Government is placing increased emphasis in its acquisitions on “past performance” as a source selection evaluation factor. You have been provided as a reference in response to the subject solicitation for Pump Out & Clean Septic Tank Services, Okinawa, Japan in order for the Government to evaluate the past performance of the firm providing you as a reference. Please provide concise comments regarding your assessment of the contractor’s performance regarding this project. In accordance with FAR 15.306(e)(4), the name of individuals providing reference information about an offeror’s past performance shall not be disclosed.

Upon completion of this survey, please send it by email to the address shown below no later than 1500 hrs Japan Standard Time (JST) on 15 August 2016.

Primary Point of Contact: Secondary Point of Contact:

SSgt Marcus Tucker MSgt Jose Hernandez Contract Specialist Contracting Officer

18 CONS/LGCA 18 CONS/LGCA

Marcus.Tucker.1@us.af.mil Jose.Hernandez.17@us.af.mil

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

1. RESPONDENT INFORMATION:

Please provide the information requested below to assist the 18th Contracting Squadron. You may be contacted for additional information pertaining to past/present performance of the contractor identified below. This information will be kept confidential.

Name of Company:

Point of Contact:

Telephone Number:

Email Address:

Attachment #5 Past & Present Performance Questionnaire

FA5270-16-R-0021

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_603 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5837

2. CONTRACT INFORMATION. Please provide the following information about the contractor who provided or are currently providing services for your company/agency:

Contractor:

Contractor’s address:

Point of Contact:

Contract Number, if applicable:

Period of Performance (the entire period) (Ex. From May 2011 to May 2014):

Contract Type: Fixed Price Cost Reimbursement Other

Contract Amount Per Year:

Prime contractor: YES NO

Description of Work Performed:

What services were/are currently provided to your company? Please describe it concretely. Also, what is the level of complexity?

Attachment #5 Past & Present Performance Questionnaire

FA5270-16-R-0021

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_603

3. PERFORMANCE INFORMATION: The definitions for the adjectival rating categories are provided below:

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

Unsatisfactory

During the contract period, contractor performance is not meeting (or did not meet) contract requirements. For any problems encountered, corrective action did not solve the problem on its own or has not solved the problem at all. Customer involvement was required.

Was the Contractor’s Performance Satisfactory as defined above? Yes No

The undersigned hereby confirms that the information provided in this document is correct as written.

Should any corrections be required, the undersigned shall contact the Contract Specialist at via email at Marcus.Tucker.1@us.af.mil no later than 1500 hrs JST on 15 August 2016. This confirmation shall allow the 18th Contracting Squadron to use the information contained herein as source selection information. Thank you very much for your assistance.

Signature Date:

Attachment #5 Past & Present Performance Questionnaire

FA5270-16-R-0021

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_603 mailto:Marcus.Tucker.1@us.af.mil