QUESTIONAIRE.doc

Transient Alert Services Tinker AFB

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: ____________________

CAGE Code: ___________________________

Address: ______________________________

Telephone Number: ____________________

Email Address: ____________________

Point of Contact: ____________________

Project Title or Brief Description of Work*:__________________________________

Contract Number*: _________________________ Contract Amount: ___________________

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

To be completed by the respondent and returned directly to the contracting office.

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RATER INFORMATION:

Name of Rater (Primary): __________________

Title: _____________________

Address: _____________________

Telephone Number: _____________________

Email Address: _____________________

C. RETURN COMPLETED SURVEY FORM TO:

D. Performance Information: Chose the appropriate letter on the scale, (S, M, U, N, UK) that most accurately describes the contractor’s performance or situation. Please provide a narrative explanation for any rating of U (unsatisfactory).

SATISFACTORY (S)

(GREEN)

During the contract period, contractor performance is meeting (or met) all contract requirements. For any problems encountered, contractor took effective corrective action.

MARGINAL (M)

(YELLOW)

During the contract period, contractor performance is not meeting (or did not meet) some contract requirements. For problems encountered, corrective action appeared only marginally effective, not effective, or not fully implemented. Customer involvement was required.

UNSATISFACTORY (U)

(RED)

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

NOT APPLICABLE (N)

(WHITE)

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

CONTRACTOR’S NAME: _________________________________________________

CONTRACT NUMBER: __________________________________________________

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

10. For Firm-Fixed Priced Contracts, did the contractor, for reasons other than wage determinations, ask for an equitable adjustment? (YES ( NO

11. Would you award another contract to this contractor? If not, explain. (YES ( NO

The space below is provided to allow for any explanation of an rating of Unsatisfactory.

SrA Nick Hazelett �AFSC/PZIOA�Nicholas.Hazelett@us.af.mil �405-739-4987

Nino Lenora�AFSC/PZIOA Antonino.Lenora@us.af.mil �405-739-4033

FOR OFFICIAL USE ONLY