Attachment 3 Past Performance Survey Ceremonial Swords.doc

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FA7000-11-T-0006

Attachment 3

PAST PERFORMANCE SURVEY

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.

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: ________________________________________*

*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. Information will be kept confidential.)

Name of Respondent: ______________________________________________________________________________

Company/Organization: ______________________________________________________________________________

Title: Local Admistrator______________________________________________________________________________

Address: __________________________________________________________________________________________

Telephone Number: ____________________________________ Fax Number:___________________________________

Relationship and time involved with Program/Contract:

Date you completed this questionnaire:____________________________________________________________________

FAX or E-MAIL COMPLETED SURVEY FORM TO:

FAX: LGCB ATTN: Jon J Wilczynski, Contracting Specialist or Diana South, Contracting Officer, USAFA CONTRACTING, FAX (719) 333-9103

EMAIL: jon.wilczynski@usafa.af.mil

III. PERFORMANCE INFORMATION:

Choose the description of the contractor’s work that best reflects their performance using the descriptions provided below. Please provide a narrative explanation for any ratings of unsatisfactory, marginal, very good or exceptional and any other specific problems or annotations that would help us evaluate the contractor.

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.

Comments:_____________________________________________________________________

THE FOLLOWING QUESTION IS "YES/NO" IN NATURE:

8. QUALITY/SCHEDULE/BUSINESS RELATIONS. Based on your judgment of the contractor’s performance, would you award another contract to this contractor for the same product again? Please explain.

( ) Yes

( ) No

Comments:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. ADDITIONAL COMMENTS:

Thank you for 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 jon.wilczynski@usafa.af.mil, Contract Specialist, or Diana South, Contracting Officer, at (719) 333-9103.

****FOR OFFICIAL USE ONLY, ONCE COMPLETED****

PLEASE ANSWER ALL QUESTIONS. PLEASE PROVIDE ADDITIONAL COMMENTS FOR EACH QUESTION

*** FOR GOVERNMENT USE ONLY ONCE COMPLETED ***

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** FOR GOVERNMENT USE ONLY ONCE COMPLETED **