Past Performance Information Form.pdf

PAST PERFORMANCE INFORMATION FORM

The 5th Contracting Squadron, Minot AFB, North Dakota, is in the process of selecting a contractor for the Child Development Center Renovation. One of the considerations in proposal evaluation is the verification of the Quoter’s past and present performance on contracts, which reflect the Quoter’s ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had first-hand experience with a Quoter, for the evaluation of the performance on those contracts.

Please complete this form and providing comments wherever applicable. Please sign the document in the space provided. Please note, we may contact the Quoter on problem areas or concerns identified to see what corrective actions have been taken or will be taken. However, the individual's name completing the questionnaire will not be disclosed to the Quoter.

Please return the completed form as soon as possible but no later than the offer due date noted in the Solicitation.

Respondent and Contract Information:

Name of Customer/Contract:

Address:

Name and Title of Evaluator:

Signature of Evaluator and Date:

Telephone No:

Dates/Years of Performance:

Annual $ Value:

Contract Number:

Contractor performed as the Prime Contractor Sub-Contractor

Services Performed/Detailed Description of Work:

Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary, qualified personnel?

How would you rate the contractor’s past performance?

Would you award another contract to this contractor? If not, please explain:

Was the contractor ever issued a cure or show cause notice, or was the contract terminated? If yes, please explain:

Is the contract rated in CPARS? Yes No

Remarks:

SEND COMPLETED SURVEY FORM TO:

5 CONS/LGCS, 165 Missile Avenue, Minot AFB, ND 58705 ATTN: Capt Taylor L. Seely EMAIL:taylor.seely@us.af.mil

DUTY PHONE: (701) 723-2262

mailto:nikole.braddy@us.af.mil