PAST_PERFORMANCE_QUESTIONNAIRE.doc

FA6633-17-R0001

May 2017

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

The information obtained from this questionnaire will be used to evaluate past performance of offerors submitting a proposal in response to the Minneapolis-St Paul Air Reserve Station Solicitation # FA6633-17-R-0001 for Repair/Maintain Aircraft Parking Ramp, Project QJKL 18-0016.

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

Contractor’s Name: ____________________ Telephone Number: _________________

Address: __________________________ Fax Number:_______________________

__________________________ Point of Contact____________________

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: __________________________

Organization _____________ ____________________________________________

Address: __ ______________________ Telephone Number: _______ ___________

Fax Number:____________ __ _________

Email Address: ____ __________________

FAX, EMAIL, or MAIL COMPLETED SURVEY FORMS TO:

*DO NOT SEND BACK TO THE CONTRACTOR*

934 CONF/LGC – Attn: Carolyn Lohman (Solicitation FA6633-17-R-0001) Fax: 612-713-1425 E-mail Carolyn.Lohman.1@us.af.mil (612) 713-1430 Mailing Address:

934 CONF/LGC

Attn: Ms Carolyn Lohman Solicitation FA6633-17-R-0001 760 Military Highway, Bldg 729 Minneapolis, MN 55450-2100

PERFORMANCE INFORMATION: Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows: (B, P, G, Y, R and N).

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF Y or R.

Very Good

Applicable

CONTRACTOR/SUBCONTRACTOR ’S NAME: ______________________________________________

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.

Pages may be included if more space is needed for additional remarks.

When Filled in This Document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

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

REMARKS:__________________________________________________________________________