Attachment 4 PPQ for Falconry Services.doc

FA5613-12-R-0009

Attachment 4

PAST PERFORMANCE QUESTIONNAIRE

This Acquisition is for Falconry Services at Ramstein Air Base.

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 ( Joint Venture Partner ( 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:

Primary

Alternate 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:

Attn: 700 CONS/LGCA Attn: 700 CONS/LGCA

Ms. Svetlana Allendorf or Ms. Kylie Hager Svetlana.allendorf@ramstein.af.mil kylie.hager@ramstein.af.mil

011-49-631-536-6885or DSN 489-6885 011-49-631-536- 6609 or DSN 489-6609

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATING GIVEN.

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 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.

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

CONTRACTOR’S NAME:

CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

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

Strengths:

Weaknesses:

Other Remarks:

CONTRACTOR’S NAME:

CONTRACT NUMBER:

For Official Use Only