Exhibit_C__info_FormsSSS__SA_and_UR_Mar_2013.pdf

EXHIBIT C PACKAGE INFORMATION AND FORMS

EXHIBIT C PACKAGE INFORMATION AND FORMS - A “Final” Performance Evaluation (Construction) ( also referred to as

CCASS Evaluation ) issued for a project may be included in lieu of sending out reference package for the project. Place the CCASS form directly behind the Exhibit A it is applicable to.

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 Reference Package (Exhibit C). For Government contracts, send to

Contracting Officer or Technical Representative. For commercial references send to personnel with duties similar to those for

Government contracts. Offerors should follow-up and encourage references to get the questionnaires to the Contracting Officer in a timely manner. If you have multiple references at one location (Base etc.), send one cover letter and questionnaire for each contract you want a reference for. Your questionnaire package should contain the following:

Cover Letter (See SAMPLE) (Exhibit C1)

Respondent Info Rating Sheets (Exhibit C2)(the next 5 pages) - Offeror should put name in spaces indicated and ensure it is on every page for identification purposes.

Suggested - Pre Addressed stamped envelope to return to Contracting Officer.

OFFEROR SHOULD PLACE THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE!!!

OFFEROR SHOULD DELETE THESE INSTRUCTIONS BEFORE SENDING OUT QUESTIONNAIRES

EXHIBIT C1

SAMPLE TRANSMITTAL LETTERAND PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Your Company Letterhead

Date: _________________

To: ______________________________________

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm has submitted a proposal under a project advertised by the 183FW Illinois Air National Guard, Mission Support Base Contracting Office. 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 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. A completed CCASS Evaluation for a DoD project or similar Agency appraisal form may be substituted for this reference questionnaire. 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 office is required.

Please send your completed questionnaire to the following address to arrive NOT LATER THAN 15 JULY 2015. Do not return them to our company.

183FW Base Contracting Office

Attn: SMSgt Brent Keller and SSgt Alicia Braun

3101 J David Jones Pkwy

Building P-48

Springfield, IL 62707-5001

Fax: 217-757-1307

Email: Brent.Keller@ang.af.mil and Alicia.Braun@ang.af.mil

If you have questions regarding the attached questionnaire, or require assistance, please contact SMSgt Brent Keller 217-757-1251 and/or SSgt Alicia Braun 217-757-1265 or email to: Brent.Keller@ang.af.mil and Alicia.Braun@ang.af.mil. Thank you for your assistance. E-Mail is preferred.

Signature and Title mailto:Brent.Keller@ang.af.mil mailto:Alicia.Braun@ang.af.mil mailto:Brent.Keller@ang.af.mil mailto:Alicia.Braun@ang.af.mil

RATING DESCRIPTIONS: Use the following descriptions as guidance in providing ratings.

THE QUESTIONNAIRE SHOULD BE SUBMITTED BY THE FOLLOWING MEANS:

Return via FAX Commercial 217-757-1307 DSN 892-8307 or via email to the email address shown above. Forms may be mailed to

183FW Base Contracting Office, Attn: SMSgt Brent Keller and SSgt Alicia Braun, 3101 J David Jones Pkwy, Building P-48, Springfield, IL 62707-5001.

Mark cover sheet: (Attention: RFP W91SMC-15-R-0005 “Source Selection Sensitive Information”)

RATING DEFINITION

Outstanding (O) Indicates the contractor’s performance record within the area of evaluation

Exceeded that required by the contract.

Above Average (AA) Indicates the contractor’s performance record within the area of evaluation

Met All contractual requirements.

Satisfactory (S) Indicates the contractor’s performance record within the area of evaluation

Met Essentially All contractual requirements.

Marginal (M) Indicates the contractor’s performance record within the area of evaluation

Met Some of the contractual requirements. However, changes to the contractor’s existing processes may be necessary in order to achieve contract requirements.

Unsatisfactory (U) Indicates the contractor’s performance record within the area of evaluation

Failed to Meet the minimum Government requirements.

Unknown or Not Applicable (N/A) The question does not apply. No performance record identifiable within the area of evaluation.

SOURCE SELECTION SENSITIVE WHEN COMPLETED

*****NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS*****

(Exhibit C2) RESPONDENT IDENTIFICATION AND RATINGS

(Part 1 Contractor submitting Proposal fill-in)

RESPONDENT IDENTIFICATION AND RATINGS

(Part 1 Contractor submitting Proposal fill-in)

Reference is provided for:

Contract Number:

Project Title:

Date of Award:

Project Completion Date:

Project Location:

Dollar Value: $

Brief Description of Proj:

Your role in referenced contract:

(Part 2 Person providing Reference)

Reference is provided by:

Company/Agency:

Business Address:

Telephone Number:

Email Address:

Project Completion Date:

Relationship to Contract:

If information in Part I is not accurate please indicate.

OFFEROR NAME ________________________________Please circle the appropriate rating.

Please provide evaluation of the following Performance Elements by placing an X in the appropriate column that corresponds to the rating definitions on the previous page.

QUALITY CONTROL

Outstan ding

Above

Averag e

Satisfa ctory

Margin al

Unsatis factory

Not

Appli cable

(O) (A) (S) (M) (U) (N/A

Quality of Workmanship

Adequacy of the quality control plan

Implementation of the Quality Control Plan

Quality of the Quality Control Documentation

Storage of Materials

Adequacy of Materials

Adequacy of Submittals

Adequacy of Quality Control Testing

Adequacy of As-Builts

Use of Specified Materials

Identification/Correction of Deficient work in a timely manner

Comments on Quality Control:

TIMELY PERFORMANCE

(O) (A) (S) (M) (U) (N/A)

Adequacy of Initial Progress Schedule

Adherence to Approved Schedule

Resolution of Delays

Submission of Required Documentation

Completion of Punchlist Items

Submission of Updated and Revised Progress

Schedules

Warranty Response

Comments on Timely Performance:

EFFECTIVENESS OF MANAGEMENT

Cooperation and Responsiveness

Management of Resources/Personnel

Coordination and Control of

Subcontractors

Adequacy of Site Clean Up

Effectiveness of Job-Site Supervision

Compliance with Laws and

Regulations

Professional Conduct

Review/Resolution of Subcontractor

Issues

Implementation of Subcontracting Plan

Comments on Effectiveness of Management:

COMPLIANCE WITH LABOR STANDARDS

Correction of Noted Deficiencies

Payrolls Properly Completed and Submitted

Compliance with Labor Laws and Regulations with Specific Attention to the Davis-Bacon Act and EEO Requirements

Comments on Compliance With Labor Standards:

COMPLIANCE WITH SAFETY STANDARDS

Adequacy of Safety Plan

Implementation of Safety Plan

Correction of Noted Deficiencies

Comments on Compliance With Safety Standards:

OVERALL RATING of PERFORMANCE (O) (A) (S) (M) (U) (N/A)

Please provide any additional information you feel is important and not covered elsewhere in this evaluation:

How effective was the contractor in meeting the contract’s sustainability requirements?

IF USGBC LEED® rating was required indicated level specified and level achieved in remarks.

Thank you for your remarks. Be sure to return to the Contracting Agency and not to the Contractor you are providing a reference for.

NAME__________________________________Contact Phone Number:____________________________

Respondent Signature ______________________________________Date Completed:_______________

OFFEROR NAME ________________________________