Atch 3 - Past Perfomance Questionnaire.pdf

Refuse and Recycle Services Laughlin Air Force Base, TX

FA3099-22-Q-0019

Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name: ____________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________*

Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 to 5 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: _____________________ _____________________________ Email Address: _____________________

C. EMAIL COMPLETED SURVEY FORM TO:

Forward the Past Performance Questionnaires (PPQs) to the POC responsible for monitoring contract performance. The responsibility to send out and ensure Government receipt of the PPQs rests solely with the Offeror. The Offeror shall exert its best effort to ensure that a current POC, per relevant contract, submits a completed PPQ directly to the Government not later than August 17, 2022 at 4:30 PM central standard time (CST). The contract POCs shall return the questionnaires, Email and Telephone Contact Information via email DIRECTLY to Karla Renovato-Faz at karla.renovato-faz@us.af.mil and Mr. Alejandro Alvarado at alejandro.alvarado.3@us.af.mil no later than August 17, 2022 at 4:30 PM CST. Any questionnaires not returned directly to the Government POCs, or received after the due date, will not be reviewed and evaluated. Do not send the completed questionnaire to the contractor.

mailto:charles.frerich@us.af.mil

FA3099-22-Q-0019

Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U in the remarks section at the bottom of page 3.

E G S M U N Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

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.

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.

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.

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.

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.

Unable to provide a score.

Performance in this area is not applicable to the effort assessed.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

FA3099-22-Q-0019

Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

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

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

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

4. Reported all airfield violations promptly

5. Followed approved quality control plan.

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

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

8. Provided timely resolution of contract discrepancies.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules.

13. Met established project schedules.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

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

18. Paid subcontractors/suppliers in a timely manner.

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

20. Cooperated with Government personnel after award.

21. How would you rate the contractor's overall performance?

22. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” YES/NO

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

YES/NO

24. Is the contractor rated in CPARS? YES/NO

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

FA3099-22-Q-0019

Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

Remarks:______________________________________________________________________