FMO ATTCH 3 -PP QUESTIONNAIRE.docx

CONTRACTOR NAME: _______________ CONTRACT/PROJECT NUMBER:_________

ATTACHMENT #3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

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

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________*

Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ _ Telephone Number: ________________________

Fax Number:___________________ Email Address: ____________________________

C. EMAIL via SCAN/ATTACHMENT or FAX COMPLETED SURVEY FORM TO:

steven.quillin@lakenheath.af.mil & keaston.simmons@lakenheath.af.mil or Fax to 01638 52 2189

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (S or U) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF U.

Performance meets contractual requirements. The contractual performance of the element or sub-element may have contained some minor problems for which corrective actions taken by the contractor were satisfactory.

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) for which the contractor’s corrective actions appear or were ineffective.

Place an “X” in the appropriate column using the definitions matrix above.

Reviewer’s Follow-up, Comments/Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note: While these questions are generic and will work as written in many acquisitions, consider them as they relate to each individual acquisition and tailor them as needed and appropriate. Also, when tailoring the form, consider leaving space between questions for comments.

RFP FA5587-11-R-0006 Source Selection Information – See FAR 2.101 and FAR 3.104 Page 1 Attachment 3