Past Performance Questionnaire Revised Oct 18, 2018.pdf

Attachment 4

PAST PERFORMANCE EXPERIENCE INFORMATION FORM

(To be completed by Contractor)

1. Contractor:

Name:

Address:

2. Contract /Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

4. Contract/TO /PO Status: Active Complete

Completion Date (w/ extensions):

5. Project Title:

Location:

6. Project Description-- to include the role of the contractor on the project and specific responsibilities of the contractor in performance of the effort:

7. Project Owner or Project Manager for the Client – provide:

Name:

Address:

Telephone Number and E-mail:

PPQ, 10/18/18

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

SIR/RFO No. 6973GH-19-R-00002 AMCD Administrative Services

PAST PERFORMANCE QUESTIONNAIRE

Attachment 4

To: _______________________________________________________________________

Organization:_____________________________________________________________

Fax No.: _________________________ E-mail Address:_________________________

Date: __________________________ Number of Pages (including this sheet): 5 in total

Your name was provided as a past performance point of contract for the following:

Contractor Name:_________________________________________________________

Contract Number: _______________________________ Date(s)____________________

Project Title: ___________________________________________________________

Contractor Role / Responsibility (circle one): Prime Contractor Sub-Contractor

In regard to the above contractor’s performance on the referenced contract, please complete the attached Past Performance Questionnaire and return as follows:

Send to: Cynthia Cooper, Contracting Officer

E-mail Address: cynthia.cooper@faa.gov

Please provide your response no later than 2:00 p.m. CDT on November 4, 2018.

Thank you!

SIR/RFO No. 6973GH-19-R-00002 AMCD Administrative Services

PAST PERFORMANCE QUESTIONNAIRE

Attachment 4

A. Please complete and/or verify the following reference check information:

1. Name of Contractor: ____________________________________________________

2. Type of contract/agreement for pricing; e.g., firm fixed-price, fixed rate per hour (labor-hour, T&M), cost-reimbursable:

3. Contract Number: _________________________________

4. Cage Code of contract contract was awarded to: _______________

5. Was this contract competitively awarded? Yes ____ No ____

6. Original Total Contract Amount: $____________________________

7. Current/Final Total Contract Amount $_________________________

8. Date of Contract Award: ____________________________

9. Contract Period of Performance: Start _________________ Complete_____________

B. Please complete and/or verify the following responder information:

Name of Responding Point of Contact: _____________________________________________________

Agency/Organization: _________________________________________________________________

Mailing Address: __________________________________________________________

Telephone Number: __________________________________

E-mail Address: __________________________________

SIR/RFO No. 6973GH-19-R-00002 AMCD Administrative Services

PAST PERFORMANCE QUESTIONNAIRE

Attachment 4

1. How would you rate the contractor's overall compliance with contract requirements?

( ) Acceptable

( ) Unacceptable

2. How would you rate the timeliness of the Contractor's service - delivered reports on time and adhering to the required schedule?

( ) Acceptable

( ) Unacceptable

3. Did the contractor commit adequate resources in a timely manner to solve problems?

( ) Yes / If yes, please explain and indicate the status.

( ) No/If no, please explain and indicate the status.

4. How would you rate the timeliness of responses to inquiries or other administrative matters?

( ) Acceptable

( ) Unacceptable

5. To what extent did the contractor provide timely assistance when responding to problems?

( ) Acceptable

( ) Unacceptable

6. If applicable, to what extent did the contractor meet the proposed cost estimates?

( ) Acceptable

( ) Unacceptable

7. How would you rate the contractor's initiative, if any in reducing overall costs to the Government?

( ) Acceptable

( ) Unacceptable

8. Has this contract been partially or completely terminated for default, or is a termination pending?

( ) Yes / If yes, please explain and indicate the status.

( ) No/Acceptable

9. Has it ever been necessary to send this Contractor a Notice to Cure letter?

( ) Yes If yes, please explain and indicate the status.

( ) No

10. How would you rate the performance of the contractor's key personnel?

( ) Acceptable

( ) Unacceptable

11. Would you recommend awarding similar contracts or using the offeror again for future work?

( ) Yes/Acceptable

( ) No/Unacceptable

12. Did you experience any integrity problems with this Contractor?

( ) Yes If yes, please explain.

( ) No

SIR/RFO No. 6973GH-19-R-00002 AMCD Administrative Services

PAST PERFORMANCE QUESTIONNAIRE

Attachment 4

9. Was a Cure Notice or Show Cause Notice issued in relation to contract performance?

( ) Yes / If yes, please explain and indicate the status.

( ) No/Acceptable

10. Would you recommend future contract awards to this contractor?

( ) Yes /Acceptable ( ) No/If no, please explain.

10. Please provide any other comments you may have.

16- Attachment 14 Past Performance Questionnaire