Atch 3 - Past Performance Questionnaire.pdf

When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

The 436th Contracting Squadron is in the process of competitively selecting a contractor to provide a broad range of design-build and construction projects affecting real property at Dover Air Force Base, Dover DE 19902.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than the proposal due date.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to john.porter.23@us.af.mil and sharon.frasier.2@us.af.mil. Your completed questionnaire will become a part of the official Source Selection records. Please keep in mind that questionnaires must be sent by the organization completing the questionnaire. No questionnaires will be accepted by the potential offeror.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

DANA M. DEYAMPERT

CONTRACTING OFFICER

1 Atch

Past Performance Questionnaire

SOLICITATION NO.: FA449720R0004

CONTRACT NO.:

Attachment 3 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836 mailto:sean.burney.1@us.af.mil mailto:wanda.wilson.1@us.af.mil

SOLICITATIONNO.: FA449720R0004

CONTRACT NO.:

Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONAIRE

*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.

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 0Sub-Contractor.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

E-Mail:

C. E-MAIL COMPLETED SURVEY FORM TO: john.porter.23@us.af.mil sharon.frasier.2@us.af.mil

D. CONTRACT NO:

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

F. AWARDAMOUNT:

G. TYPE OF CONTRACT:

H. PERFORMANCE PERIOD: From To

J. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS:

and

SOLICITATIONNO.: FA449720R0004

CONTRACT NO.:

Attachment 3

K. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, V, S, M, U, and NIA) that most accurately describes the contractor's performance or situation. PLEASE PROVIDE A

NARRATIVE EXPLANATION FOR ANY RATINGS OF M O R U.

E V s M u NIA Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Performance meets Performance meets Performance meets Performance does not Performance does not Unable to provide a rating.

contractual requirements contractual requirements contractual requirements. meet some contractual meet/did not meet most Contract did not include and exceeds many and exceeds some The contractual requirements. The contractual requirements performance for this requirements to the requirements to the performance being contractual performance and recovery is not likely aspect, performance was Government's benefit. Government's benefit. assessed contains some being assessed reflects a in a timely manner. The not observed, or The contractual The contractual minor problems for which serious problem for which element or sub-element information was not performance being performance being corrective actions taken by the contractor has not yet contains a serious available. Do not know.

assessed was assessed was the contractor appear or identified corrective problem(s) for which the accomplished with few accomplished with some were satisfactory actions or the contractor's contractor's corrective minor problems for which minor problems for which proposed actions appear actions appear or were corrective actions taken by corrective actions taken by only marginally effective ineffective the contractor were highly the contractor were or were not fully effective. effective. implemented.

The contractor: E V s M u NIA

1. Provided experienced managers and supervisors with the technical 0 0 0 0 0 0 and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, 0 0 0 0 0 0qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors 0 0 0 0 0 0 commensurate with contract requirements.

4. Home office participated in solving significant local problems. 0 0 0 0 0 0

5. Followed approved quality control plan. 0 0 0 0 0 0

6. Provided effective quality control and/or inspection procedures to 0 0 0 0 0 0meet contract requirements.

7. Corrected deficiencies in a timely manner and pursuant to quality 0 0 0 0 0 0control procedures.

8. Provided timely resolution of contract discrepancies. 0 0 0 0 0 0

9. Identified problems as they occurred. 0 0 0 0 0 0

10. Suggested alternative approaches to problems. 0 0 0 0 0 0

11. Displayed initiative to solve problems. 0 0 0 0 0 0

12. Developed realistic progress schedules. 0 0 0 0 0 0

13.

14.

15.

16.

17.

18.

19.

20.

a.

b.

21.

22.

23.

24.

SOLICITATIONNO.: FA449720R0004

CONTRACT NO.:

Attachment 3

The contractor: E V s M u NIA

Met established project schedules. 0 0 0 0 0 0 Provided timely resolution of warranty defects. 0 0 0 0 0 0 Was responsive to contract changes. 0 0 0 0 0 0 Provided adequate project supervision. 0 0 0 0 0 0 Obtained consent of surety for increases in bonding as work-in- 0 0 0 0 0 0 progress increased.

Paid subcontractors/suppliers in a timely manner. 0 0 0 0 0 0 Provided accurate and complete line item cost proposals including all 0 0 0 0 0 0 aspects of work required for each task.

With respect to the safety plan, the contractor:

Followed the approved safety plan. 0 0 0 0 0 0 Had no significant safety problems at the job site. 0 0 0 0 0 0 Cooperated with Government personnel after award. 0 0 0 0 0 0 Was the contractor ever issued a cure or show cause notice under the Yes 0 No 0 referenced contract? If yes, explain outcome in "remarks."

Would you award another contract to this contractor? If not, explain Yes 0 No 0 in "remarks."

Has contractor demonstrated a history of environmental compliance with respect to erosion and sediment control on construction sites? If Yes 0 No 0 not, explain in "remarks."

Remarks: