Attachment 5 Past Performance Questionnaire.pdf

Attachment 5

Past Performance Questionnaire

SAMPLE COVER LETTER:

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a contract in support of Security Equipment Systems

Integration required by the Transportation Security Administration.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at ___________________

Contractor POC

1 Atch

Past and Present Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm

A. GENERAL INFORMATION:

Contractor’s Name: ____________________ Address: __________________________

Telephone Number: ____________________ __________________________

Fax Number: ____________________ __________________________

Point of Contact: ____________________

Project Title or Brief Description of Work: ___________________________________________*

Contract Number Provided by Offeror: ____________________ Dollar Amount: $ _________*

Contract Period or Dates of Performance Provided by Offeror: __________________________*

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. FAX COMPLETED SURVEY FORM TO: ____________________________________

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5 6

NO CONFIDENCE LITTLE

CONFIDENCE

UNKNOWN

CONFIDENCE

SATISFACTORY

CONFIDENCE

SIGNIFICANT

CONFIDENCE

HIGH

CONFIDENCE

Based on the offeror’s performance record, extreme doubt exists that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort.

No performance record is identifiable.i

Based on the offeror’s performance record, the government has confidence the offeror will successfully perform the required effort.

Normal contractor emphasis should preclude any problems.

Based on the offeror’s performance record, the government has significant confidence the offeror will successfully perform the required effort.ii

Based on the offeror’s performance record, the government has high confidence the offeror will successfully perform the required effort.iii

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER________________

The Contractor:

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 3 4 5 6

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

1 2 3 4 5 6

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6

4. Followed approved quality control plan. 1 2 3 4 5 6

5. Provided effective quality control and/or inspection procedures to meet contract requirements.

1 2 3 4 5 6

6. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5 6

7. Provided timely resolution of contract discrepancies. 1 2 3 4 5 6

8. Identified problems as they occurred. 1 2 3 4 5 6

9. Suggested alternative approaches to problems. 1 2 3 4 5 6

10. Displayed initiative to solve problems. 1 2 3 4 5 6

11. Developed realistic progress schedules. 1 2 3 4 5 6

12. Met established project schedules. 1 2 3 4 5 6

13. Provided timely resolution of warranty defects. 1 2 3 4 5 6

14. Was responsive to contract changes. 1 2 3 4 5 6

15. Provided adequate project supervision. 1 2 3 4 5 6

16. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6

17. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6

18. Cooperated with Government personnel after award. 1 2 3 4 5 6

19. How would you rate the contractor's overall performance? 1 2 3 4 5 6

20. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

21. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER:_______________

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

Please reference question number before providing remarks.

Remarks:

Contractors Name:____________________________ Contract Number:______________________