EXHIBIT A PAST PERFORMANCE QUESTIONNAIRE TEMPLATE.docx

APPENDIX A

TEMPLATE – PAST PERFORMANCE QUESTIONNAIRE AND COVER LETTER

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a (Describe type of contract.) contract at ____________AFB, ___.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at ___________________

Contracting Officer

1 Atch Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name/Division: __________________________________________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________* Contracting Agency/Customer: _______________________________________________* Contract Period of Performance: ______________________________________________* Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* 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. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

C. FAX COMPLETED SURVEY FORM TO: __________________________________

(Insert name and fax number of Contracting Officer or Past Performance evaluation team Chairperson that the completed Questionnaires are to be sent to.)

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, V, 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.

Performance meets/met 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 was not observed or not applicable to the current effort being reported against.

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.

Quality of Service

Comments:

Timeliness of Performance

Business Relations

OTHER

Remarks:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________