Past_Performance_Questionnaire_(2).doc

NAF01

PAST PERFORMANCE QUESTIONNAIRE

CONCESSIONAIRE – JUICE AND BEVERAGE CONCESSION

(THE OFFEROR SHALL PROVIDE THIS ATTACHMENT TO CUSTOMERS, INDIVIDUALS OR OTHER GOVERNMENT OFFICES WHO HAVE KNOWLEDGE OF THE OFFEROR'S PAST AND PRESENT PERFORMANCE) Please email the completed questionnaire no later than the offer due date located in the Solicitation to:

Samantha Carlstrom

60 CONS/LGCC

350 Hanger Ave bldg. 549 Travis AFB, CA 94535 Email: samantha.carlstrom.1@us.af.mil Part 1: CONTRACT IDENTIFICATION

********************The Contractor Must Fill out This Section********************

(Customer must circle concur or does not concur on the following page)

The following information is needed to help evaluate and determine your past performance. Please complete the following items and submit with your proposal. Provide a separate completed form for each contract/program submitted.

The names of at least two (2) companies/agencies you have had contracts with in which you performed a similar service for a period of at least 2 year, to include points of contact and phone numbers.

A. Offeror Name (Company/Division): ________________________________________

B. Program/Project Title: ____________________________________________________ C. Contract Specifics:

1. Contracting Agency or Customer: _________________________________________

2. Contract Number ______________________________________________________

3. Location/Address______________________________________________________

4. Period of Performance __________________________________________________

5. Hours worked per week (min 40) _________________________________________

6. Current/final Contract Cost/Price _________________________________________

7. Annual Contract Dollar Value ____________________________________________ D. Brief Description of Effort as _______ Prime or _______ Subcontractor

E. Primary Customer Point of Contact:

1. Name ___________________________ Address _________________________ Telephone _______________________

Contractor’s Signature Date Part 2: EVALUATION *********************The Customer Must Fill Out Remaining Sections*********************

Customer concurs / does not concur with contractor’s statements on previous page.

Performance Information: Please indicate your satisfaction with the contractor’s performance by circling the appropriate rating using the scale provided. For ratings above or below satisfactory, please comment on how the contractor either exceeded your requirement or how the contractor failed to meet your requirement. If the contractor had problems in a specific area, but you determined them to have no impact on the mission, please specify this in your narrative remarks. If the statement is not applicable, circle N for “Neutral”.

When responding to this questionnaire, please use the following definitions as a guide:

Performance Confidence Assessment E.

Exceptional Performance met all contract requirements and exceeded many. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

V.

Very Good Performance met all contract requirements and exceeded some. There were a few minor problems for which the contractor resolved in a timely, effective manner.

S.

Satisfactory Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

N.

Neutral Did not observe performance in this area. No record of performance or the record is inconclusive.

M.

Marginal Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

U.

Unsatisfactory Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

1. PERFORMANCE REQUIREMENTS

COMMENTS/REMARKS:

2. MANAGEMENT EFFECTIVENESS

3. QUALITY OF SERVICE AND WORKMANSHIP

4. TIMELINESS/ADHERENCE TO SCHEDULES

5. CUSTOMER SATISFACTION

6. COMPLIANCE WITH ENVIRONMENTAL/LABOR/SAFETY REQUIREMENTS

1. During the course of the contract, was notification sent to the contractor identifying unsatisfactory work?

FORMCHECKBOX

Yes (please explain)

No

2. Based on your judgment of the contractor’s performance, would you award the contractor another Government contract?

Yes

No (please explain)

3. Please rate the overall consistency and reliability of the contractor’s performance.

Exceptional Very Good Satisfactory

Neutral Marginal Unsatisfactory

4. Please rate overall customer satisfaction with the contractor's performance.

Exceptional Very Good Satisfactory

Neutral Marginal Unsatisfactory

Part 3: EVALUATOR INFORMATION

The following information will help us track the responses received, as well as resolve whatever differences may arise between your perception of the contractor’s performance and the contractor’s perception of their performance. You are advised that the Air Force FAR Supplement (AFFARS) requires that the Offeror be given an opportunity to respond to adverse past performance information.

a.

Evaluator’s Name:

b.

Title:

c.

Telephone Number: DSN:

Commercial:

d.

Organization, Office Symbol, and Address:

e.

Length of involvement in the contract:

f.

Date of questionnaire completion:

Again, thank you for your time and effort in assisting us with our requirement.