Attachment__4 _PPQ.doc

Attachment 4 RFP No: FA5613-13-R-0020 Cleaning of Hoods and Ducts in the Kaiserslautern Military Community (KMC)

PAST PERFORMANCE QUESTIONNAIRE

This Acquisition is for the Cleaning of Hoods and Ducts in Dining Facilities in the Kaiserslautern Military Community (KMC).

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.

RATER INFORMATION:

Name of Rater:

Title:

Address:

Telephone Number:

Email Address:

C. RETURN COMPLETED SURVEY FORM NO LATER THAN 28 JUNE 2013 BY 1600 (CET) TO:

Andrea Strong

Contract Specialist

700 CONS/LGCE

andrea.strong@us.af.mil +49-631-536-6598

DSN 489-6598

Mark Jenkins

Contracting Officer

700 CONS/LGCE

mark.jenkins.1@us.af.mil +49-631-536-6870

DSN 489-6870

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:

RATER’S NAME:

RATER’S SIGNATURE:

For Official Use Only