EXHIBIT D Past Performance Cover Sheet and Questionnaire.docx

EXHIBIT D

FA7022-11-R-0024

EXHIBIT D

FA7022-11-R-0024

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for an operations and maintenance services contract at Patrick AFB, FL.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at 321-494-5189.

1 Atch:

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: ________________________________________

Contract Number/Type: _______________________________________________________

Period of Performance: ________________________________________________________

Original Contract $ Value: ______________________________________________________

Current Contract $ Value: ______________________________________________________

Reason for differences between original contract value and current contract value: _________

B. RESPONDENT INFORMATION:

The following information will assist in the analysis of data. Information will be kept confidential.

Name of Respondent: _____________________ Title: ___________________________

Length of Involvement in Program/Contract: ________________________________________

C. EMAIL OR FAX COMPLETED SURVEY FORM TO: LeShan R. Gardner; Email: leshan.gardner@patrick.af.mil; Fax # 321-494-5403.

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 in the Remarks section.

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.

Place an “X” in the appropriate column using the definitions matrix above.

YES/NO

YES/NO

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Source Selection Sensitive IAW FAR 2.101 and FAR 3.104