Attachment 5 PPQ.doc

Attachment 5

FA5613-12-R-0001

PAST PERFORMANCE QUESTIONNAIRE

This Acquisition is for Preventive Maintenance, Safety Inspections and Repairs of Elevators and Escalators in the Kaiserslautern Military Community (KMC), Ramstein Air Base, Landstuhl-Kirchberg, Kaiserslautern-Vogelweh and Kaiserslautern-Kapaun.

A.

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

Contractor’s Name:

Address:

Telephone Number:

Email Address:

Point of Contact:

Project Title or Brief Description of Work*:

Contract Number*:

Contract Amount:

Contract Period or Dates of Performance*:

Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

To be completed by the respondent and returned directly to the contracting office.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

B.

RESPONDENT INFORMATION:

Name of Respondent:

Name of Respondent:

Title:

Title:

Telephone Number:

Telephone Number:

Email Address:

Email Address:

C. RETURN COMPLETED SURVEY FORM WITHIN 4 WORKING DAYS AFTER RECEIPT TO:

Erika Voss-Elsaesser/Contract Specialist Inge Jenkins/Contracting Officer

700 CONS/LGCE

and

700 CONS/LGCE

erika.voss-elsaesser@ramstein.af.mil inge.jenkins@ramstein.af.mil +49-631-536-6809 or DSN 489-6809 +49-631-536- 6800 or DSN 489-6800

CONTRACTOR’S NAME:

CONTRACT NUMBER:

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

Performance meets contractual requirements with many exceeded to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

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

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element 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.

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.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME:

CONTRACT NUMBER:

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

If yes, explain outcome in “remarks.”

YES / NO

Remarks:

For Official Use Only