Attachment 3 - Past Performance Questionnaire.doc

Offeror’s Name:________________________________________

Solicitation: FA5685-11-R-0010

MEMORANDUM FOR WHOM IT MAY CONCERN

39th CONS/LGCA

Unit 7090 Box 127

APO AE 09824-0127

FROM:

Subject: Request for Performance Information, Solicitation # FA5685-11-R-0024 Title: Paint IDIQ

1. One of the integral considerations in proposal evaluations is the verification of the offeror’s past performance on contracts, which reflect the offeror’s ability to perform on the proposed effort. This effort, solicitation number FA5685-11-R-0024 is to paint various facilities at Incirlik Air Base in Adana, Turkey. Due to the high consideration given to the offeror’s past performance, we request that you complete and return the attached questionnaire.

2. Our areas of interest are summarized in the enclosed questionnaire. You are urged to submit your comments on similar programs for which your activity has contracts or administers contracts with the offeror. You may also provide any additional information that you think would benefit our office in our evaluation of the offeror’s proposal. Please note that we may contact the offeror to discuss problem areas or concerns you identify to see what corrective actions have been taken or will be taken to prevent similar situations in the future. However, the offeror was required to provide points of contact for each reference provided to the US Government, and the individual’s name completing the questionnaire will not be disclosed to the offeror.

3. Due to time constraints, it is important that the questionnaire be completed and returned by the date proposals are due to the following address:

39th CONS/LGCA

Attn: TSgt Terry Agena

Unit 7090 Box 127

APO AE 09824-0127

“Mark documents “SOURCE SELECTION SENSITIVE/FOR OFFICIAL USE ONLY”

Completed questionnaires may also be faxed to (322) 316-1090 or DSN (314) 676-8075, or emailed to terry.agena@incirlik.af.mil and rebecca.hoyt@incirlik.af.mil.

4. If additional information is required, please contact, TSgt Terry Agena or SSgt Rebecca Hoyt at (322) 316-8083.

CLARISSA LOPEZ

Contracting Officer

Attachment:

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SOLICITATION NUMBER: FA5685-11-R-0024

PAINT IDIQ

SECTION 1: GENERAL INFORMATION

A. Offeror's Name:______________________________________________

B. Cage Code under which contract was performed:____________________

C. Contract number / Program Title:_________________________________

D. Contract type (ex: FFP, Cost, T&M):______________________________

E. Was this a competitive contract? Yes No

F. Was it a design-build contract? Yes No

G. Period of Performance (number of days):___________________________

H. Performed duties as: Prime Contractor Sub-contractor

I. If performed as a Prime Contractor, was there Sub-contractors? Yes No

J. Initial (at time of award) contract value: $_______________

K. Current/final contract value: $_______________

L. Reasons for differences between initial contract value and final contract value:

M. Description of work provided:

N. To help determine program relevancy, please indicate below the work the contractor has or is performing under this contract by placing an “X” or check mark in the appropriate block:

A-E Design work

Civil (pavements, site utilities) and/or Structural work

Electrical and/or Communications work

Mechanical (plumbing, HVAC) work

Fire Protection work

Security (secure rooms for classified work) and/or Force Protection work

New Construction (including building additions)

Interior renovation

SECTION 2: CUSTOMER/AGENCY/COMPANY IDENTIFICATION

A. Customer/Agency/Company Name:______________________________________________

B. Address:

C. Telephone Number:_____________________________________

D. Fax Number:____________________________________

E. Email Addres:_______________________________________________________________

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator’s Name:________________________________________________

B. Evaluator’s Title:_________________________________________________

C. Evaluator’s Phone Number:_________________________________________

D. Evaluator’s Signature:_____________________________________________

SECTION 4: EVALUATION

Evaluation Instructions: Please choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. A definition of each rating is provided below. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Performance meets contractual requirements with many exceeded to the Government’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 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.

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

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NO

NO

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NO

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