Attach_04_ArmDrm_Exhibit_A_Past_Performance_Questionaire.docx

EXHIBIT A

PAST PERFORMANCE REFERENCE

QUESTIONNAIRE

Solicitation: W50S8F-24-R-0002 Project: Mill & Overlay Airfield Pavements Offeror:

Instructions to Offeror for sending Reference Questionnaire Forms:

Prepare and submit to the owners of the projects listed in your Exhibit A “Performance Relevancy Questionnaires”, a Past Performance Reference Questionnaire (Exhibit C). For Government contracts, the Client POC should be the Contracting Office. For commercial references, send to personnel with duties similar to those for Government contracts. Offerors should follow-up and encourage references to return completed questionnaires in a timely manner. If you have multiple references at one location (i.e. at a military base), send one cover letter and questionnaires for each contract for which you need a reference. Your questionnaire package should contain the following:

· Cover Letter (See SAMPLE on the next page)

· Respondent Info Rating Sheets (Exhibit C) (the following 4 pages). Offeror should put name in spaces indicated and ensure it is on every page for identification purposes.

OFFEROR SHOULD PLACE THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE

In accordance with SECTION 00120 – PROPOSAL EVALUATIONS AND BASIS FOR AWARD, completed questionnaires should be sent directly to the Contracting Office.

OFFEROR SHOULD DELETE THESE INSTRUCTIONS BEFORE SENDING OUT QUESTIONNAIRES

SAMPLE TRANSMITTAL LETTER FOR

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Offeror’s Company Letterhead

Date:

To Client:

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm will be submitting a proposal under a project advertised by the 177th Fighter Wing, New Jersey Air National Guard in Egg Harbor Township, NJ. In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance. Your candid response to the attached questionnaire will assist the government evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible. Space is provided for comments. Only one response from each office is required. Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306(e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each firm is required.

Please return your completed questionnaire directly to the 177th Fighter Wing Contracting Office via email to:

177fw.contracting.org@us.af.mil

This documentation must arrive NOT LATER THAN [offeror to enter date], so that it can be evaluated by the Government with our proposal.

If you have questions regarding the attached questionnaire, or require assistance, please contact the 177th Fighter Wing Contracting Officer, MSgt Kirk Sherry at 177fw.contracting.org@us.af.mil and kirk.sherry@us.af.mil via email (preferred) at: or alternatively by telephone at 609-761-6096. Thank you for your assistance.

Signature and Title

National Guard PAST PERFORMANCE QUESTIONNAIRE (Exhibit A)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor / Offeror Information Firm Name: CAGE Code:

Address: SAM UEI Number:

Phone Number: Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub-Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify): Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy): Actual Completion Date (mm/dd/yy): Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

THE 177th FIGHER WING CONTRACTING OFFICE REQUIRES THE CLIENT COMPLETE THIS

QUESTIONNAIRE AND RETURN DIRECTLY TO:

177fw.contracting.org@us.af.mil

THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

(U) Unsatisfactory

TO BE COMPLETED & RETURNED BY CLIENT ONLY

Return Directly to: 177fw.contracting.org@us.af.mil

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

b) Ability to meet quality standards specified for technical performance

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

3. CUSTOMER SATISFACTION:

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U N

7. GENERAL

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):