Atch_3_-_MERC-G_PPQ.docx

Source Selection Information -- See FAR 2.101 and 3.104

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

SUBJECT: Request for Past and Present 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 advisory and assistance service contract at Patrick AFB, FL.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact Ms. Denise Adams at 321-494-9683 or denise.adams.5@us.af.mil or the undersidned at 321-494-5206 or laurie.rowe@us.af.mil.

Laurie A. Rowe Contracting Officer

Attachment: Past and Present Performance Questionnaire When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

When Filled

In

This

Document Is

Source

Selection

Sensitive

IAW

FAR

2.101 and

FAR

3.104

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Offeror’s Name: Address:

Telephone Number: Fax Number: Point of Contact:

(The offeror must enter this information in accordance with L-III, paragraph 6., E. to the references stated in the Past Performance Volume.)

Contract Period or Dates of Performance:_______________________________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

Contract type: _________________Was this a competitive contract? Yes _____ No ____ Period of performance: ____________________________________________________ Initial contract cost: $______________________ Current/final contract cost: $________________ Reasons for differences between initial contract cost and final contract costs: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: _____________________

Telephone Number:

Fax Number:

Email Address:

Contractor Cage Code: __________ _______

C. EMAIL COMPLETED SURVEY FORM TO: Ms Denise Adams; Email: denise.adams.5@us.af.mil or Ms. Laurie Rowe; Email: laurie.rowe@us.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.

*CONTRACTOR’S NAME: CONTRACT NUMBER:

*Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

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

YES/NO

YES/NO

CONTRACTOR’S NAME:

CONTRACT NUMBER

Remarks:

CONTRACTOR’S NAME:

CONTRACT NUMBER

Source Selection Information -- See FAR 2.101 and 3.104