Attachment 11 - Past Performance Questionnaire.pdf

Attachment 10

FA301022R0040

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 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. SEND COMPLETED SURVEY FORM TO: 81st Contracting Squadron, Keesler AFB, MS

Attn: TSgt Lovely Herndon Fax # 228-377-3298 Email: lovely.herndon@us.af.mil &

81CONS.LGCB.Construction@us.af.mil

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, VG, S, M, U, and N?A) that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E VG S M U N/A

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

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.

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.

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.

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.

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.

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.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

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

The contractor: E VG S M U N/A

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. Home office participated in solving significant local problems.

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

The contractor: E VG S M U N/A 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 __________

Remarks:______________________________________________________________________