A10 Questionnaire.pdf

Questionnaire

SUBJECT: Request for Past Performance Evaluation

You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for the Electric Personnel Door Repair and Maintenance at Joint Base McGuire-Dix-Lakehurst, NJ.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact Lisa Goodwin at lisa.goodwin.2@us.af.mil.

Patrick Duff Contracting Officer mailto:lisa.goodwin.2@us.af.mil

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

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 5 years, please complete separate evaluation forms for those contracts as well.

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

A. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number: Email Address:

B. EMAIL COMPLETED SURVEY FORM TO:

lisa.goodwin.2@us.af.mil and patrick.duff.5@us.af.mil.

mailto:lisa.goodwin.2@us.af.mil mailto:patrick.duff.5@us.af.mil

C. PERFORMANCE INFORMATION: Choose the number on the scale of 0 to 5 that most accurately describes the contractor’s performance or situation. Indicate Not Applicable (N/A) as necessary.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS.

PERFORMANCE

RATING DEFINITION

(5) Exceptional Performance meets contractual requirements and exceeds many requirements to the Government’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.

(4) Very Good Performance meets contractual requirements and exceeds some requirements to the Government’s 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.

(3) Satisfactory Performance meets contractual requirements. The contractual performance of the element being assessed contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(2) Marginal Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s actions appear only marginally effective or were not fully implemented.

(1) Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

(0) Not Applicable Unable to provide a score. Performance in this area is not applicable to the effort assessed.

CONTRACTOR’S NAME: CONTRACT NUMBER

The contractor:

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

4. Home office participated in solving significant local problems.

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

7. Identified problems as they occurred.

8. Suggested alternative approaches to problems. 0 1 2 3 4 5 N/A

9. Displayed initiative to solve problems.

10. Provided adequate project supervision.

11. Perform repair and maintenance in a complete and professional manner.

0 1 2 3 4 5 N/A

12. Has performed preventative maintenance and repair of electric personnel doors.

0 1 2 3 4 5 N/A

13. Cooperated with Government personnel after award. 0 1 2 3 4 5 N/A

14. How would you rate the contractor's overall performance on this contract?

0 1 2 3 4 5 N/A

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

Yes No

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

Yes No

Remarks: