L4_-_Past_Performance_Questionnaire.docx

DEPARTMENT OF THE ARMY

U.S. ARMY MISSION AND INSTALLATION CONTRACTING COMMAND-JBLM

BOX 339500, MS 19, 2015 N. 4th STREET

JOINT BASE LEWIS-MCCHORD, WA 98433-9500

REPLY TO

ATTENTION OF:

SECTION L, ATTACHMENT L4

CCMI-CBR-LM

MEMORANDUM FOR Questionnaire POCs SUBJECT: Request for Source Selection Information

1. The Mission and Installation Contracting Command (MICC) at Joint Base Lewis-McChord (JBLM), Washington is in the process of selecting a contractor for Fort Bliss Grounds Maintenance Services at Fort Bliss, Texas. Request for Proposal Solicitation Number W911S8-18-R-0014. Detailed information regarding this solicitation may be found at www.fbo.gov.

2. One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts, which reflect the Offeror's ability to perform on the proposed effort. The Government depends on information received from agencies such as yours, which have had firsthand experience with an offeror, for the evaluation of the Offeror's performance on those contracts.

3. The Government’s areas of interest in the Offeror are summarized in the enclosed questionnaire. Request your written response in accordance with FAR Clause 52.212-1 Addendum, Paragraph (3)(iii). This schedule will allow sufficient time to analyze the data prior to the start of negotiations. It is important that you return the completed questionnaire directly to the Government.

4. To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and "emailed" to jose.f.diaz1.civ@mail.mil. Please call (253) 966-3483 prior to transmission or if you have any questions. Your completed questionnaire will become a part of the official Source Selection records.

5. Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN, THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

SECTION 1: CONTRACT IDENTIFICATION

1. Contractor: ___________________________________________________________________________

1. Cage Code: _________________________________

1. Contract number: _______________________________________

1. Contract type: ______________________________

1. Was this a competitive contract? Yes _____ No _____

1. Period of performance: _________________________________________________________

1. Initial contract cost: $____________________________

1. Current/final contract cost: $_______________________________

1. Reasons for differences between initial contract cost and final contract costs:

1. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

1. Customer or agency name: ___________________________________________________________________________

1. Customer or agency description (if applicable): ___________________________________________________________________________

1. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

1. Evaluator's name: ___________________________________________________________________________

1. Evaluator's title: ___________________________________________________________________________

1. Evaluator's phone/fax number: ___________________________________________________________________________

1. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

A ACCEPTABLE – Based on the Offeror’s performance record, the offeror successfully performed the required effort, or the Offeror’s performance record was unknown.

U UNACCEPTABLE – Based on the Offeror’s performance record, the offeror unsuccessfully performed the required effort.

N/A NOT APPLICABLE – Unable to provide a score.

The questions shown below should be tailored to the Factors/Subfactors of the instant acquisition.

Please respond “Yes” or “No”:

For Federal Contracts Only:

21a. If Yes, please describe reason and final outcome.

22a. If Yes, please describe reason and final outcome.

23a. If Yes, please describe reason and final outcome.

24. Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

24a. If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

25. What is/was the duration of the contract? ________________________________________

26. Please discuss each and every response for which you indicated U (Unacceptable) in response to the questions above (use additional sheets, if necessary).

27. NARRATIVE SUMMARY

28. Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

29. Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Preferred Method:

E-mail: jose.f.diaz1.civ@mail.mil, Please use encryption and confirm with receipt confirmation

Secondary Method:

Mailed to:

Mission and Installation Contracting Command (MICC)

MICC – JBLM

ATTN: Jose Diaz Box 339500, MS 19, 2015 N. 4th Street Joint Base Lewis-McChord, WA 98433-9500 image1.png