Attachment_2 _Questionnaire.docx

FA7000-16-T-0089

Past Performance Survey Attachment 4

FA7000-16-T-0089

Past Performance Questionnaire Attachment 2

PAST PERFORMANCE QUESTIONNAIRE

This attachment will not be incorporated into the resultant contract.

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

This questionnaire is for the United States Air Force Academy Contracting Office.

Bio-solid, Grease Traps, Sand Traps, Oil Water Separators, Septic Tanks, Cesspools

Your contractor is being considered for a contract to perform non-hazardous waste collection and disposal services for the USAF Academy, Colorado. A primary consideration in our selection process is history of performance of similar efforts. Please send completed questionnaire directly to Thomas Rokita by 9 September 2016. Do not forward questionnaire to vendor.

TELEPHONE: 719-333-9629

FAX: 719-333-6608

E-MAIL: thomas.rokita@us.af.mil

VENDOR: __________________________________________________________________

RESPONDENT:

Name: _____________________________________ Title: _______________________________________

Organization and Address: __________________________________________________________________

Telephone: ___________________ E-mail: ______________________________

CONTRACT WITH RESPONDENT:

Title: ___________________________________________________________________________________ Period of Performance: __________________________ Contract Number: __________________________ Dollar Amount: ___________________________________________________________________________ Services Performed: _______________________________________________________________________

PERFORMANCE:

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

Applicable

During the contract period, contractor performance is meeting (or met) all contract requirements and consistently exceeding (or exceeded) many. Very few, if any minor problems encountered. Contractor took immediate and effective corrective actions.

During the contract, period contractor is meeting (or met) all contract requirements and exceeding (or exceeded) some. Some minor problems encountered. Contractor took timely corrective action.

During the contract period, contractor performance is failing (or failed) to meet most contract requirements. Serious problems encountered. Corrective actions were either ineffective or non-existent. Extensive customer oversight and involvement was required.

Unable to provide a rating. Contract did not include performance for this aspect. Do not know.

PLEASE ANSWER ALL QUESTIONS. PLEASE PROVIDE ADDITIONAL COMMENTS FOR

EACH QUESTIONS.

QUALITY

COMMENTS:

SCHEDULE

MANAGEMENT

COMMNETS:

OVERALL

ADDITIONAL COMMENTS: _________________________________________________________________________________________

Thank you for completing the questionnaire.

The completed questionnaire is to ONLY be viewed by the Government. Do not submit a copy of the completed questionnaire to anyone other than Thomas Rokita, Contract Specialist, or Carol Mohr, Contracting Officer.

FAX or E-MAIL COMPLETED QUESTIONAAIRE FORM TO:

FAX: ATTN: Thomas Rokita, Contract Specialist, or Carol Mohr, Contractor Officer, 10 CONS/LGCA, FAX (719) 333-6608

E-MAIL: thomas.rokita@us.af.mil or carol.mohr@us.af.mil

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

** FOR GOVERNMENT USE ONLY ONCE COMPLETED**

**FOR GOVERNMENT USE ONLY ONCE COMPLETED**