Attch_05_-__Past_Performance_Questionnaire.doc

Past and Present Performance Questionnaire Solicitation FA7000-10-R-0036

Attachment 5

Attachment 5

FA7000-13-R-0007

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

(The format to be used shall be substantially as follows:)

Company:

Date

Address:

1. We are contemplating offering a proposal for a solicitation from the 10th Contracting Squadron located at United States Air Force Academy, CO. The solicitation is for Chemical Portable Toilets Services and Rentals. This proposal requires that we provide past performance information. Please complete the attached past performance questionnaire and return it via mail, fax or email to:

Mail:

10 CONS/LGCA

Attn: FA7000-13-R-0007/Aaron Vollbracht 5226 Cedar Drive USAF Academy, CO 80840-2315 Fax: 719-333-9705

E-mail: aaron.vollbracht@us.af.mil

2. In order to ensure this questionnaire is considered, please forward this survey to arrive at the above address, no later than 24 April 2013 at 12:00 PM, MST. Upon completion, please notify my office that the survey has been accomplished.

Name & Title of Individual

Name of Company

1 Attachment:

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

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: ____________________________

Address: _____________________

Telephone Number: ___________________ _____________________________

Fax Number:

Email Address: _____________________

C. RETURN COMPLETED QUESTIONNAIRE VIA MAIL, FAX OR EMAIL TO:

Mail:

10 CONS/LGCA

Attn: FA7000-13-R-0007/Aaron Vollbracht 5226 Cedar Drive USAF Academy, CO 80840-2315 Fax: 719-333-9075

E-mail: aaron.vollbracht@us.af.mil 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 Exceptional, Marginal or Unsatisfactory. A block for the narrative is provided at the end of each Section for Quality of Work, Technical Performance, Schedule and Business Relations.

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” in the appropriate column using the definitions matrix on the previous page.

YES/NO

YES/NO

YES/NO