ATCH 5 Past Performance Questionnaire.pdf

FA466126Q0074

PAST PERFORMANCE OUESTIONAIRE

The below-named Contractor/Offeror is being considered for award of a contract for Unaccompanied Housing Wi-Fi Internet Services at Dyess AFB, TX. A primary consideration in our selection process is the Contractor's history of performance of similar efforts. Please make every effort to be thorough in your answers/comments. Completed questionnaires can be returned via email to the following:

7th CONS/PKB ATTN: Bennie Simmons and SrA Way Spikes Email: bennie.simmons@us.af.mil and way.spikes@us.af.mil

A. GENERAL INFORMATION

Offeror's Name:

Address:

Offeror's Cage/DUNS:

Telephone Number:

Point of Contact:

B. RESPONDENT INFORMATION

Name:

Title:

Organization & Address:

Telephone: FAX: _

Email:

mailto:victor.camacho.2@us.af.mil mailto:amanda.fragoso@us.af.mil mailto:cris.hernandez@us.af.mil

C. CONTRACT INFORMATION

Contract Title:

Period of Performance:

Contract Number:

Total contract value, including all modifications and options:

Description of contract effort:

D. PERFORMANCE INFORMATION

The Air Force will use your survey responses to determine a level of confidence, based on the Offeror's past performance record, concerning the Offeror's ability to successfully perform our requirement in accordance with the contract.

RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCEINFORMATION TO

OFFEROR SUBMITTING A PROPOSAL FOR THIS SOLICITATION.

In the table below, indicate your rating for the contractor's performance by placing an "X" in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL - Performance meets contractual requirements and exceeds many requirements to the Government's benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD - Performance meets contractual requirements and exceeds some requirements to the Government's benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY - Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL - Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.

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

NIA NOT APPLICABLE - Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

E. PERFORMANCE EVALUATION AREAS

Please use the above ratings and their assigned definitions to describe the Offeror's performance in the following areas:

The Contractor: E V s M

1. Assigned personnel with the required skills to accomplish the work.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

3. Home office participated in solving significant local problems.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

5. Followed approved quality control plan. SUPPORTING INFORMATION:

6. Identified problems as they occurred. SUPPORTING

INFORMATION:

u NIA

The Contractor: E V s M u NIA

7. Displayed initiative to solve problems.

SUPPORTING INFORMATION:

8. Developed realistic progress schedules.

SUPPORTING INFORMATION:

9. Met established project schedules.

INFORMATION:

10. Provided timely resolution of warranty defects.

SUPPORTING INFORMATION:

11. Hired experienced subcontractors.

SUPPORTING INFORMATION:

12. Paid subcontractors/suppliers in a timely manner.

SUPPORTING INFORMATION:

13. Completed appropriate preventive maintenance of telecommunication equipment.

SUPPORTING INFORMATION:

14. Completed work orders on schedule.

SUPPORTING INFORMATION:

15. Managed work orders without hindering operation and maintenance efforts. SUPPORTING INFORMATION:

16. Provided accurate and appropriate technical solutions. SUPPORTING INFORMATION:

The Contractor: E V s M u NIA

17. Maintained maintenance and work order records.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

F. Did the Contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? If yes, please describe:

G. If given the opportunity, would you award another contract to this Contractor?___

Please explain response below:

Signature of Respondent Date_

Job Title:

Thank you for taking the time to complete this questionnaire.

LEGEND OF TERMS

OFFEROR: The Contractor for which past performance is being evaluated

SOLICITATION NUMBER: The procurement document number the Government uses to identify a specific Request for Proposal (RFP)

RESPONDENT: The person and/or organization evaluating past performance

CONTRACT NUMBER: If the Offeror had a contract or purchase order with your company/firm, the identifying contract number associated with awarded contract/purchase order

CONTRACT TITLE: Project title of work performed

CONTRACT VALUE: Contract/purchase order total dollar value, including all modifications and options

BRIEF DESCRIPTION OF WORK: Describe type of work being performed, to include personnel, equipment, tools, supervision, and other items and services.

Thank you for your prompt response and assistance!

LEGEND OF TERMS