Attachment 11 - Past performance Questionnaire.pdf

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire

For Official Use Only

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? Yes No

L. Contractor’s Role: Prime Contractor Subcontractor Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

FA460822R0001

Attachment 11

Past Performance Questionnaire

For Official Use Only

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

Section 4: Performance Information

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.

Past Performance Questionnaire

For Official Use Only

N/A 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.

Note: The following are SAMPLE questions. Past Performance evaluation teams MUST construct a simple and concise Past Performance Questionnaire, tailored to seek out key information tied to the significant aspects of the planned acquisition. Avoid questions that can be answered with a “yes” or “no” but instead include probing and direct questions to draw out the required information desired.

The Contractor: E V S M U N/A

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

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

4. Home office participated in solving significant local problems.

SUPPORTING INFORMATION:

5. Followed approved quality control plan.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

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

Past Performance Questionnaire

For Official Use Only

The Contractor: E V S M U N/A

SUPPORTING INFORMATION:

8. Provided timely resolution of contract discrepancies.

SUPPORTING INFORMATION:

9. Identified problems as they occurred.

SUPPORTING INFORMATION:

10. Suggested alternative approaches to problems.

SUPPORTING INFORMATION:

11. Displayed initiative to solve problems.

SUPPORTING INFORMATION:

12. Developed realistic progress schedules.

SUPPORTING INFORMATION:

13. Met established project schedules.

SUPPORTING INFORMATION:

14. Provided timely resolution of deficiency.

SUPPORTING INFORMATION:

15. Was responsive to contract changes.

SUPPORTING INFORMATION:

16. Provided adequate project supervision.

SUPPORTING INFORMATION:

Past Performance Questionnaire

For Official Use Only

The Contractor: E V S M U N/A

17. Paid subcontractors/suppliers in a timely manner.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

19. Cooperated with Government personnel after award.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

21. Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain.

EXPLANATION:

Yes

No

22. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

Yes

No

IF THIS WAS A GOVERNMENT CONTRACT:

Did this contract include FAR 52.219-9, Small Business Subcontracting Plan?

Yes No

If yes, did the contractor comply with the clause? Please explain.

Did this contract include FAR 52.219-8, Utilization of Small Business Concerns?

Past Performance Questionnaire

For Official Use Only

Yes No

If yes, did the contractor comply with the clause? Please explain.

Additional remarks:

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: thomas.hutchins@us.af.mil and christopher.mitchell.36@us.af.mil

DUTY PHONE: (318) 456-4007 (318) 456-6739