EXHIBIT D Past Performance Cover Sheet and Questionnaire.docx

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Attached to
EDAPT Federal contract opportunity
Solicitation number
FA702211R0029EDAPT
Issued by
Department of the Air Force Air Combat Command

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Exhibit D

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EXHIBIT D

FA7022-11-R-0029

EXHIBIT D

FA7022-11-R-0029

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 321-494-7320.

//signed//
MICHELLE RAINESContracting Officer

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: ___________________________

Address: _____________________Telephone Number: ___________________ _____________________________Fax Number:_____________________
_____________________________Email Address: _____________________

Length of Involvement in Program/Contract: ________________________________________

C. EMAIL OR FAX COMPLETED SURVEY FORM TO:

Michelle Raines; Email: michelle.raines@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.

E
G
S
M
U
N
Exceptional
Good
Satisfactory
Marginal
Unsatisfactory
Neutral

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.

The contractor:
E
G
S
M
U
N
1.
Overall performance in planning/managing the effort.
2.
Overall consistency, quality, and reliability of performance.
3.
Effectiveness in maintaining continuity of mission support while transitioning/phasing-in sources and personnel.
4.
Adherence to required deliveries of technical data, documents, and software submitted in accordance with contractual specifications.
5.
Potential problems/delays are communicated to the customer in time to mitigate impact to schedule.
6.
Compliance with contract terms and conditions.
7.
Working relationships (both management and technical) with government and/or other contractor personnel.
8.
Ability to comply with security requirements.
9.
Managing and resolving problems.
10.
Ability to meet or exceed small business goals set forth in the approved subcontracting plan.
11.
Ability to keep personnel current with state-of-the-art technology.
12.
Ability to recruit and retain a qualified staff to meet contractual requirements.
13.
Ability to obtain and maintain required personnel security clearances.
14.
Demonstrated ability to maintain inventory control of government-furnished equipment
15.
Responsiveness to contract changes.
16.
Provided adequate project supervision.
17.
Paid subcontractors/suppliers in a timely manner.
18.
Provided accurate and complete line item cost proposals including all aspects of work required for each task.
19.
Cooperated with Government personnel after award.
20.
How would you rate the contractor's overall performance?
21.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

22.
Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

23.
Is the contractor rated in CPARS?
YES/NO

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________
Evaluator’s SignatureDate

Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

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