PAST_PERFORMANCE_QUESTIONNAIRE.doc

Attachment 5 FA7000-11-R-0020 Performance Questionaire

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 10 Contracting Squadron located at United States Air Force Academy, CO. The solicitation is for the Protective Coatings and Pavement Markings project. 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: David Willers/FA7000-11-R-0020 8110 Industrial Drive, Suite 200

USAF Academy, CO 80840-2315 Fax: 719-333-6608 e-mail: david.willers@usafa.af.mil

2. In order to ensure this questionnaire is considered, please forward this survey to arrive at the above address, no later than 1 September 2010. Upon completion, please notify my office at __________ (phone number) 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 LGC/LGCA

Attn: David Willers /FA7000-11-R-0020 8110 Industrial Drive, Suite 200

USAF Academy, CO 80840-2315 Fax: 719-333-6608 e-mail: david.willers@usafa.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 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” in the appropriate column using the definitions matrix above.

YES/NO

YES/NO

YES/NO