Attachment J.3 Past Performance Questionnaire.pdf

ATTACHMENT J.3, PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO THE REFERENCE

FOR COMPLETING THE PAST PERFORMANCE QUESTIONNAIRE

Handwritten completion of this questionnaire is acceptable, if legible.

Include evaluation of contractor's performance based solely on the performance for which the contractor was/is liable.

Please do not let factors beyond the control of the contractor which have resulted in performance delays or other problems bias the evaluation of the contractor's performance.

The following is a definition of the scoring system used:

6:Exceptional- Performance meets contractual requirements and exceeds many to the Owner’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective and timely.

5:Very Good- Performance meets contractual requirements and exceeded some to the governments benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective and timely.

4: Satisfactory- Performance met contractual requirements. The contractual performance of the area being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

3: Neutral- no record of past performance or the record is inconclusive.

2: Marginal- Performance did not meet some contractual requirements. The contractual performance of the element being assessed contained serious problem(s) for which the contractor’s corrective actions appear or were marginally effective.

1: Unsatisfactory- Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective

In completing the questionnaire please circle a number corresponding to your rating, or "N/A" if you are unable to provide an evaluation for any area.

Please provide clear and concise narrative explanations (both positive and negative) for your answers. This is especially important for any rating above or below “satisfactory”. If more space is needed than is provided, you may attach additional sheets.

Questionnaires must be received not later than the closing date of the solicitation. Offerors are responsible for ensuring their references transmit the questionnaire to the Contracting Office.

Attention: Cilony Alejandro T: 405-954-7814

Email:

Cilony.Alejandro@faa.gov mailto:Cilony.Alejandro@Faa,gov

SIR/RFO DTFAAC-16-R-02685

PAST PERFORMANCE QUESTIONNAIRE

(To be completed by the Referenced POC with the Offeror’s Business and Project Information)

I. CONTRACTOR/CONTRACT IDENTIFICATION.

A. Contractor (Company/Division):

B. Contract Number/Identification:

C. Location Information: City, State and FAA ID and Facility Type (if applicable):

D. Contract Title (Brief Description of Work and Location):

E. Contract Type: Fixed-Price, Cost-Reimbursement;

F. Owner: Federal / State / Local Government or Private/Commercial:

G. Period of Performance:

H. Original Dollar Amount of Contract:

I. Number of Modifications:

J. Dollar Amount at Completion (or current amount, if not complete):

II. PAST PERFORMANCE/QUALITY EVALUATION:

1. Quality of Product or Service - Assess the contractor’s conformance to contract requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards):

6 5 4 3 2 1 Comments:

2. Schedule - Assess the timeliness of the contractor against the completion of the contract, task orders, milestones, delivery schedules, administrative requirements (e.g., efforts that contribute to or effect the schedule variance): 6 5 4 3 2 1 Comments:

3. Cost Control (Not applicable if the referenced contract was firm fixed price) - Assess the contractor’s effectiveness in forecasting, managing and controlling contract cost:

6 5 4 3 2 1 Comments:

4. Business Relationships - Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, completeness and quality of problem identification, corrective actions plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior, customer satisfaction, and the timely award and management of subcontracts. Additionally, please comment as to whether the contractor met small/small disadvantaged and women-owned business participation goals:

6 5 4 3 2 1 Comments:

5. Competence of Technical Staff – Assess the technical capabilities of the contractor’s staff. Were technical solutions to your environmental problems developed that saved you time and money? Were you involved by the contractor in the technical planning of projects? Were the contractor’s ideas repeatedly rejected or significantly modified by regulatory agencies? Were innovative technologies used?

6 5 4 3 2 1 Comments:

6. If you had a choice, would you use this company again? Yes No

Explain:

7. Other contacts who may be able to furnish past performance information:

RESPONDENT INFORMATION

[DO NOT RELEASE OUTSIDE OF THE GOVERNMENT – SOURCE SELECTION SENSITIVE

DATA]

A. NAME OF EVALUATOR:

B. TITLE:

C. TELEPHONE NUMBER: E-MAIL ADDRESS:

D. COMPANY/ORGANIZATION:

E. POSITION HELD IN REFERENCE TO THE CONTRACT

(TECHNICAL INSPECTOR, CONTRACT ADMINISTRATOR, ETC.):

F. LENGTH OF INVOLVEMENT IN CONTRACT:

G. WAS THE OFFEROR GIVEN THE OPPORTUNITY TO RESPOND TO ALL

ADVERSE PAST PERFORMANCE INFORMATION? Yes No Not Applicable Unknown Explain:

H. DATE QUESTIONNAIRE COMPLETED/INFORMATION PROVIDED:

I. IF THE INFORMATION WAS SUBMITTED IN WRITING, THE SIGNATURE OF THE

RESPONDENT:

Signature Date