4. Past Performance Questionnaire - AG WELLS CVIA H2 B5.pdf

ATTACHMENT - INSTRUCTIONS TO OFFERORS (ITO)

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Agricultural Well CVIA, H2 & B5 Past Performance Questionnaire

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

SECTION 1: CONTRACT IDENTIFICATION

Contractor: _________________________________

Cage Code of contractor contract was awarded to: _________________________________

Contract number: _______________________________________

Contract type: ______________________________ (If multiple types (i.e. Firm-Fixed Price with Time & Material), list percentage and dollar amount of Firm-Fixed Price portion)

Was this a competitive contract? Yes _____ No _____

Did this contract include Design-Build efforts ? Yes _____ No _____

Did this contract include Bonding ? Yes _____ No _____

Period of performance: _________________________________________________________

Initial contract price: $____________________________

Current/final contract price: $_______________________________

Reasons for differences between initial contract price and final contract price:

Description of service provided:

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SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

Customer or agency name:

Customer or agency description (if applicable):

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

SECTION 3. EVALUATOR IDENTIFICATION

Evaluator's name:

Evaluator's title:

Evaluator's phone/fax number:______________________________________________________ Evaluator’s email: __________________________________________________________________

Number of years evaluator worked on subject contract: ___________________________________

ATTACHMENT - INSTRUCTIONS TO OFFERORS (ITO)

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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

G- GREEN/SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Y- YELLOW/MARGINAL – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

R- RED/UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N- NOT APPLICABLE - Unable to provide a score.

G Y R N Special Standards of Responsibility/Bonding T1. Contractor ability and qualifications to manage and execute design-build projects.

T2. Contractor ability to have a sound staffing approach to include subcontractor and teaming arrangements.

T3. Contractor ability to staff appropriate key positions in management/administrative staff as well as field construction staff; such as Project Manager, Project Superintendent, Safety Manager and Quality Control Manager T4. Contractor ability to hire, manage, retain, and replace personnel who have the knowledge, experience, and required certifications, inclusive of the ability to meet any surge requirements.

T5. Contractor ability to provide and execute Safety Plan that demonstrates commitment to safety, training, and incident reporting and methods/procedures for implementing safety.

T6. Contractor ability to provide and execute Quality Control (QC) Plan that provides qualifications, responsibilities, and authority levels of each position assigned to the QC function.

Special Standards of Responsibility/Bonding Pl. Contractor ability to provide Work Plan and associated drawings for evaluation and execution of a construction project.

P2. Contractor ability to provide a delivery order proposal based upon the specifications and SOW provided.

P3. Contractor ability to provide a description of procedures, processes and methods for tracking progress of the project and interface with the Government, with attention to quality, timeliness, and cost control.

Please discuss each and every response for which you indicated G/S (Green/Satisfactory ), Y/M (Yellow/Marginal) or R/U (Red/Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

Government Contracts Only: Has/was this contract partially or completely terminated for default or convenience or are there any pending terminations?

No ___ Yes___ for Default___ Convenience___ Pending Terminations___

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

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SECTION 5: NARRATIVE SUMMARY

What were the contractor’s most positive aspects in the performance of the contract?

What were the contractor’s most negative aspect in the performance of the contract?

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

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

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Evaluator’s Signature Date__________________________

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

DEPARTMENT OF THE AIR FORCE

9th Contracting Squadron ATTN: A1C Madison DeGarmo / Martin Vessels 6500 B Street Beale AFB, CA 95903 madison.degarmo@us.af.mil and martin.vessels@us.af.mil mailto:Kelly.Benton@us.af.mil mailto:Dustin.Lashley@us.af.mil

ITO ATTACHMENT 1.2