4. Past Performance Survey.pdf

PAST AND PRESENT PERFORMANCE SURVEY

(Date) (Atch # 4)

FOR OFFICIAL USE ONLY

(When Filled In)

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

Address: Telephone Number:

Point of Contact:

Contractor Performed as the Prime Contractor, the Sub-Contractor.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

E-Mail:

C. FAX COMPLETED SURVEY FORM TO:

Attn:

Phone No.

OR

D. E-MAIL COMPLETED SURVEY FORM TO: mariah.thompson@us.af.mil

F. CONTRACT NO:

G. CONTRACT STATUS: (% complete, complete, just awarded, etc.)

H. AWARD AMOUNT:

I. TYPE OF CONTRACT:

A. PERFORMANCE PERIOD: From To

B. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS:

(Date) (Atch # 4)

FOR OFFICIAL USE ONLY

(When Filled In)

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

1 2 3 4 5 6

Unsatisfactory Marginal None Satisfactory Very Good Exceptional

Performance did Performance did No record of Performance Performance Performance not meet most not meet some past met contract met all met all contractual contractual performance requirements. contract contract requirements. requirements. or the record There were requirements requirements

There were There were is some minor and exceeded and exceeded serious problems, some inconclusive. problems and some to the many to the problems and of a serious corrective government’s government’s the contractor’s nature, for which actions taken by benefit. There benefit.

corrective corrective action the contractor were a few Problems, if actions were was only were minor any, were ineffective. marginally satisfactory. problems negligible and effective. which the were resolved contractor in a timely, resolved in a highly timely, effective effective manner.

manner.

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 NA

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

1 2 3 4 5 6 NA

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

1 2 3 4 5 6 NA

4. Home office participated in solving significant local problems.

1 2 3 4 5 6 NA

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

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

1 2 3 4 5 6 NA

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

1 2 3 4 5 6 NA

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

9. Identified risks/problems as they occurred. 1 2 3 4 5 6 NA

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

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

12. Developed realistic progress schedules. 1 2 3 4 5 6 NA

13. Met established project schedules. 1 2 3 4 5 6 NA

(Date) (Atch # 4)

FOR OFFICIAL USE ONLY

(When Filled In)

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

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

16. Provided adequate project supervision. 1 2 3 4 5 6 NA

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

1 2 3 4 5 6 NA

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

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

1 2 3 4 5 6 NA

20. With respect to the safety plan, the contractor:

a. Followed the approved safety plan. 1 2 3 4 5 6 NA

b. Had no significant safety problems at the job site. 1 2 3 4 5 6 NA

21. The contractor met contractual requirements for the following work elements:

NA

a. Constructed pavements and drainage structures to the specified grade and alignment requirements

1 2 3 4 5 6 NA

b. Constructed pavement sections to the specified thickness, density, and surface smoothness requirements

1 2 3 4 5 6 NA

c. Performed specified curing and protection of concrete pavement surfaces

1 2 3 4 5 6 NA

d. Mobilized and completed work in a timely manner to work orders issued under the “On Call” or Indefinite Delivery Indefinite Quantity (IDIQ) contract

1 2 3 4 5 6 NA

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

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

Y

E

S

N

O

24. Would you award another contract to this contractor?

If not, explain in “remarks.”

Y

E

S

N

O

25. Has contractor demonstrated a history of environmental compliance with respect to erosion and sediment control on construction sites? If not, explain in “remarks.”

Y

E

S

N

O

Remarks:

(Date) (Atch # 4)

FOR OFFICIAL USE ONLY

(When Filled In)