Atch3. Past Performance Questionnaire-5Apr24.docx

Controlled Unclassified Information When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

FA7014-24-R-0037 Attachment 3: Past Performance Questionnaire – SAF/FM QA Program Support Section 1: Contract Identification

A. Contractor Name & CAGE Code:

B. Point of Contact Name/Phone:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Period of Performance:

G. Contract Dollar Value:

H. Description of work performed:

Section 3: Respondent Identification

A. Respondent’s Name:

B. Respondent’s Title:

C. Respondent’s Phone/E-mail Address:

Section 4: Performance Information

In the table below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

SUPPORTING INFORMATION:

2. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Ensured performance adhered to contract requirements.

4. Complied with Financial, Environmental, Safety and Reporting requirements.

5. Identified problems as they occurred.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Provided timely resolution of contract discrepancies.

8. Met established project schedules.

9. How would you rate the contractor's overall performance on this contract?

10. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain.

EXPLANATION:

☐ Yes ☐ No

11. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

☐ Yes ☐ No

Additional remarks:

[click and pick the date]

Respondent’s Signature Date

Please return this completed questionnaire to:

E-Mail to: deanna.kerkhoff.1@us.af.mil and Brittney.devallon@us.af.mil Controlled Unclassified Information Page 8 of 8