Attachment 6_Past Performance Survey_B4 n Garment Bags.doc

FA7000-10-R-0001

Attachment 6

CONTRACTOR’S NAME: _________________________ CONTRACT NUMBER: _______________

For Solicitation FA7000-10-R-0001

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

This attachment will not be incorporated into the resultant contract.

THIS DOCUMENT, WHEN COMPLETED IS ONLY FOR VIEW BY THE GOVERNMENT.

This survey is for the United States Air Force Academy Contracting Office FAX or E-MAIL COMPLETED SURVEY FORM TO: Diana South, Contracting Officer, or Monique King-Hotop, Contract Specialist at USAFA Contracting, Fax (719) 333-9103 or e-mail to diana.myles-south@usafa.af.mil or monique.king-hotop@usafa.af.mil.

I. CONTRACT INFORMATION:

Complete the following information on the contractor that provided or is currently providing services for your company.

Contractor’s Name:______________________________________________________________ Address:______________________________________________________________________ Telephone Number:_____________________________________________________________ Point of Contact:_______________________________________________________________ Project title or Brief Description of Work:____________________________________________ Contract Number:_______________________________________________________________

Contract Value Per Year:_________________________________________________________

Contract Period or Dates of Performance:____________________________________________ Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

*Note: If offeror holds or has held more than one contract with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

II. SURVEY RESPONDENT INFORMATION:

Complete the following information on your company. You may be contacted for additional information pertaining to the past or present performance of the contractor identified in the section above. (The following information will assist in the analysis of the data. All information will be kept confidential.)

Name of Respondent: ____________________________________________________________ Company/Organization: _________________________________________________________

Title: ________________________________________________________________________

Address: _______________________________________________________________

Telephone Number: ______________________ Fax Number: ___________________

Relationship and time involved with Program/Contract: __________________________

Date you completed this questionnaire:____________________________

III. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (0 -5) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR YOUR RATINGS.

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 meets contractual requirements with some exceeded to the Government’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: _______________

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.

Remarks:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Thank you for completing this questionnaire.

The completed survey is to ONLY be viewed by the Government. Do not submit a copy of the completed survey to anyone other than Monique King-Hotop, Contract Specialist, or Diana South, Contracting Officer.

Please FAX or E-MAIL COMPLETED SURVEY FORM TO: Diana South, Contracting Officer, or Monique King-Hotop, Contract Specialist, at USAFA Contracting, Fax (719) 333-9103 or e-mail to diana.myles-south@usafa.af.mil or monique.king-hotop@usafa.af.mil.

** FOR GOVERNMENT USE ONLY ONCE COMPLETED **