Attch_6__PPQ.pdf

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

FA8751-15-R-0022

INSTRUCTIONS FOR OFFEROR

1. Offerors will complete Section A of the questionnaire (Page 2 & 3) for each reference and include with their proposal. The offeror will submit Section B of the questionnaire directly to their references and request the reference return the questionnaire directly to the Contract Specialist identified below. Offeror will complete Block 2 of Section B (Contract number and Program Name) before submitting to their references.

PROPOSAL RESPONSE DATE: 21 OCTOBER 2015

CONTRACT SPECIALIST:

NAME: ASHLEY ELLINGER

EMAIL: Ashley.Ellinger@us.af.mil

TEL: (315) 330-4496

FAX: (315) 330-2555

MAIL: AFRL/RIKO

ATTN: ASHLEY ELLINGER

26 ELECTRONIC PKWY

ROME NY 13441-4514

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

SECTION A:

Offerors will complete Section A of the questionnaire (Pages 2 & 3) for each reference and include with their proposal.

1. COMPANY NAME/ REFERENCE NAME: __________________________________________

ADDRESS: ____________________________________________________________________

TEL: ___________________________ FAX: _____________________________

EMAIL: ____________________________________________________________________

2. CONTRACT #: _______________________PROGRAM NAME:____________________________

3. CONTRACTING OFFICER (IF DIFFERENT FROM REFERENCE): ________________________

ADDRESS: ____________________________________________________________________

TEL: ___________________________ FAX: _____________________________

EMAIL: ____________________________________________________________________

4. CONTRACT TYPE: Firm-Fixed Price Cost-Reimbursement Other (describe)

5. DESCRIPTION OF WORK (Including approximate Square Yardage):

6. BRIEF DESCRIPTION OF THE EFFORT Prime ____ or Subcontractor ____

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

7. AWARD DATE: _______________ ___ SCHEDULED COMPLETION: ___________________

CURRENT / FINAL COMPLETION DATE (if different): _________________________________

8. AMOUNT PER YEAR: ___________________ CONTRACT TOTAL AMOUNT: ____________________

CURRENT / FINAL AMOUNT (if different): _________________________________________________

9. COMMENTS REGARDING COMPLIANCE WITH CONTRACT TERMS AND CONDITIONS

10. COMMENTS REGARDING ANY KNOWN PERFORMANCE DEEMED UNACCEPTABLE TO THE

CUSTOMER, OR NOT IN ACCORDANCE WITH THE CONTRACT TERMS AND CONDITIONS

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

Past Performance Questionnaire

SECTION B: Past performance reference completes this entire Past Performance Questionnaire section.

INSTRUCTIONS FOR REFERENCE

You have been identified as a past performance reference for solicitation FA8751-15-R-0022 Snow/Ice Removal at the Air Force Research Laboratory (AFRL/RRS) and Defense Finance and Accounting Service(DFAS) in Rome, NY. In order for the Government to evaluate the past performance of the Offeror identifying you as a reference, please complete Section B of this Past Performance Questionnaire, then return it to the Contract Specialist below.

The Contract Number and Program Name provided by the Offeror are found in Block #2 below. If the Offeror performed additional contracts for your organization, please provide past performance information on those contracts as well.

Response Date: 3PM 21 OCTOBER 2015

CONTRACT SPECIALIST: ASHLEY ELLINGER

AFRL/RIKO

26 ELECTRONIC PKWY

ROME NY 13441-4514

TEL: (315) 330-4496

FAX: (315) 330-2555

E-MAIL: Ashley.Ellinger@us.af.mil

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable. Thank you for your assistance.

1. NAME: ____________________________________________________________________

POSITION: ____________________________________________________________________

ADDRESS: ____________________________________________________________________

TEL: ___________________________ FAX: _____________________________

EMAIL: ____________________________________________________________________

2. CONTRACT #: _______________________PROGRAM NAME:___________________________

3. RELATIONSHIP AND TIME INVOLVED WITH OFFEROR:

4. WHAT, IF ANY, ELEMENTS OF WORK WERE SUBCONTRACTED? PLEASE ESTIMATE

THE PERCENTAGE OF THE TOTAL WORK THAT WAS SUBCONTRACTED?

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

SECTION B, CONTINUED: Please rate the offeror’s performance using the scale below.

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

Performance meets contractual requirements with many exceeded to the customer’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 customer’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.

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.

was not observed or not applicable to the current effort being reported against.

EVALUATION AREAS

I. Contractor Performance: E G S M U N

1.

Contractor provided complete and correct documentation in a timely manner in response to administrative issues and governing objectives.

2.

Contractor prevented accumulation of snow and ensured that areas were safe and had adequate de-icing materials.

3.

Contractor was responsive during any unscheduled activity or emergency calls for service.

4.

Contractor provided adequate clean-up, restoration, or repair to the serviceable area during or after the plowing season.

Comments:

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

II. Contractor Safety: E G S M U N

1.

Contractor’s Safety Plan was thorough and comprehensive. Contractor successfully implemented Safety Plan.

2.

Contractor demonstrated safe work habits through proper and adequate use of safe practices and job site protection to maintain an accident, injury, and damage free work zone.

3.

Contractor fulfilled all safety regulations without notice, warning, work suspension, or other outside motivation.

4.

Response to spills, mishaps, or other incidents was timely. Reports were made as required. Collateral risk was mitigated promptly. If no incidents for the contract, please write N/A.

Comments:

III. Overall: E G S M U N

1.

Please rate the contractor’s overall performance on this contract.

2. Please comment on the number of reported slips and falls due to winter conditions in the serviceable area during the contract?

No.__________ Costs associated with any liabilities due to the slips and falls $__________________

3. How does this contractor compare to others which have performed similar work for your Organization?

___ BEST ___ ABOVE AVG ___ AVERAGE ___ BELOW AVG ___ UNACCEPTABLE

4. Would you contract with this contractor again?

If no, please explain below. ___ YES ___ NO

SOURCE SELECTION INFORMATION

IN ACCORDANCE WITH FAR 2.101 and 3.104

Attachment 6

ADDITIONAL COMMENTS (attach additional sheets as necessary):