DRAFT_Past_Perf_Questionnaire.doc

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IN

ACCORDANCE WITH FAR 3.104

INSTRUCTIONS FOR OFFEROR:

1. Section A: The Offeror will complete Section A of the questionnaire (Page 2 &3) for each reference and include with their proposal.

2. Section B: The Offeror will complete Block 2 of Section B of the questionnaire (Contract number and Program Name) and submit Section B directly to their references. Offeror will request the reference return the questionnaire directly to the Contract Specialist identified below.

PROPOSAL RESPONSE DATE: TBD

CONTRACT SPECIALIST

NAME:

Leslie Christoferson

TEL:

(315) 330-7255

MAIL:

AFRL/RIKO

ATTN: Leslie Christoferson

26 Electronic Pkwy

Rome NY 13441-4514

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): _________________________________________

Fax:

Email:

4.

Contract Type:

Firm-Fixed Price

Cost-Reimbursement Other (describe)

5.

Description of Work:

6.

Brief Description of the Effort:

Prime ____ or Subcontractor ____

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:

11.

List all major subcontractors that worked on referenced project, in what trade, and what percentage of work done: ______________________________________________________________________________

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

INSTRUCTIONS FOR REFERENCE

You have been provided as a past performance reference in response by the Offeror to solicitation FA875119RA004 – Simplified Acquisition of Base Engineering Requirements (SABER) at the Air Force Research Laboratory’s Information Directorate, Rome NY. In order for the Government to evaluate the past performance of the Offeror providing you as a reference, please complete Section B, Past Performance Questionnaire, and return it to the Contract Specialist identified below. The Contract Number/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: TBD Leslie Christoferson, Contract Specialist

AFRL/RIKO

26 Electronic Pkwy Rome NY 13441-4514

Tel:

(315) 330-7255 or DSN 587-7255 Fax:

(315) 330-2555

E-Mail:

leslie.christoferson@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:

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?

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

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 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.

EVALUATION AREAS

Comments:

Comments:

Comments:

Comments:

Comments:

ADDITIONAL COMMENTS (attach additional sheets as necessary):

FA875119RA004

ATTACHMENT 3

PAST PERFORMANCE QUESTIONNAIRE