Attachment_4_-_Past_Performance_Questionnaire.doc

FA8601-19-R-A042

Past Performance Questionnaire Attachment 4

PAST PERFORMANCE QUESTIONNAIRE

When filled in this document is source selection sensitive information iaw FAR 2.101 & 3.104

I. INSTRUCTIONS TO RESPONDENTS: The Operational Contracting Branch at Wright Patterson Air Force Base (WPAFB), Ohio solicits your input regarding a contractor that has performed services for you in the past or is currently performing services for you. The following questionnaire will be used as part of the Government's evaluation of the contractor's proposal for Packing & Crating Services. Completed questionnaires may be mailed, FedExed, faxed or emailed. Email is preferred. If the questionnaire is to be returned via email, convert the completed questionnaire to a PDF document and email it to dustin.burch@.us.af.mil. NOTE: Questionnaires returned via e-mail must contain a subject line that reads "FA8601-19-R-A042, Packing & Crating Services." Email filters at WPAFB are designed to filter emails without su bject lines or with suspicious subject lines or contents (i.e., .exe or .zip files). Therefore, if the prescribed subject line is not included or the attachment is not in the PDF format, the e-mail may not get through the email filters.

The mailing address is:

AFLCMC/PZIBB

ATTN: Dustin Burch (Ref: FA8601-19-R-A042) 1940 Allbrook Drive, Room 109

Wright-Patterson AFB OH 45433-5344

Whether you choose to email, mail, fax, or submit completed questionnaires by other means, they must arrive not later than 3:00 P.M. Eastern Time, 2 October 2019.

Return surveys directly to the point-of-contact identified above. Do not route completed surveys through the contractor that performed services for your organization. Surveys received directly from contractors will not be used in the evaluation.

Your responses should be based on your own knowledge of the contractor’s performance, which may be supplemented by input from others in your organization with knowledge of the contractor’s performance. If you need more space than is provided, please attach a separate sheet to the end of this questionnaire.

Complete a separate questionnaire for each contract the contractor performed for your organization.

II. RESPONDENT INFORMATION:

a. Name of Respondent/Evaluator: ________________________________________

b. Name and Address of Respondent’s Organization:

c. Organizational Telephone No.: _______________________________________

d. Fax Number: _____________________________________________________

e. Email Address: ___________________________________________________

f. How long were you involved with the contract being evaluated? _________________________________________________________________________

III. GENERAL INFORMATION ON CONTRACTOR BEING EVALUATED

a. Name of the Firm: ____________________________________________________________________

b. Contract Number or Other Reference Number: ______________________________

c. Description of Services Provided:

e. Did the contractor execute an effective transition plan at the beginning of the contract to ensure it was fully operational by the start of the contract? ( ) Yes ( ) No If you answered no, please explain ____________________________________________________________________________________________________________________________________________________________

f. Did you ever have any concerns regarding the contractor's employee training program? ( ) Yes ( ) No If you answered yes, please explain ______________________________________________________________________________

g. Did you ever have any concerns regarding the contractor's employee safety program?

( ) Yes ( ) No If you answered yes, please explain ____________________________________________________________________________________________________________________________________________________________

h. Did you ever have any concerns regarding the contractor's employee well-being?

( ) Yes ( ) No If you answered yes, please explain

i. On a scale of 1-5, with 5 being the best grade, rate how well the contractor was able to adapt to changes in requirements or guidance, correct discrepancies, and/or work with government personnel to appropriately manage day to day operations.

Rating: _____ If you rated the contractor 3 or less, please explain.

j. Did you ever not pursue an option year with the contractor?

( ) Yes ( ) No If you answered yes, please explain

k. Did you ever consider not pursuing an option year with the contractor?

( ) Yes ( ) No If you answered yes, please explain

Overall Customer Satisfaction:

1. On the scale below, circle the number that indicates your organization’s overall satisfaction with the contractor’s performance.

1 – Very dissatisfied

2 – Dissatisfied

3 – Unsure

4 – Satisfied

5 – Very satisfied

Please explain if you circled numbers 1 or 2 above.

2. In a competitive situation, all other factors being equal, would you award this contractor another contract based on their past performance?

( ) Yes

( ) No

Please explain if you answered no above.

Additional Comments: Please feel free to provide any further information not covered in this questionnaire as an attachment that you feel would help us in evaluating the contractor’s past performance.

TYPED/PRINTED NAME

DATE

POSITION TITLE

SIGNATURE

Please accept our sincere appreciation for taking the time to complete this questionnaire. Your participation will be of great value to us.