ATTACHMENT 3 - Past Performance Questionnaire.pdf

ATTACHMENT 3

PAST PERFORMANCE QUESTIONNAIRE

When filled in this document is source selection sensitive information IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _______________________________________________________________________________

B. Cage Code: _________________________________

C. Contract number: _______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

D. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

A ACCEPTABLE – Based on the offeror’s performance record, the offeror successfully performed the required effort, or the offeror’s performance record was unknown.

U UNACCEPTABLE – Based on the offeror’s performance record, the offeror unsuccessfully performed the required effort.

NA NOT APPLICABLE - Unable to provide a score.

A U NA

Contractor’s overall performance and management of contract requirements

Contractor’s process for controlling work ( receiving, validating, scheduling and tracking individual contract work requests)

Contractor’s Quality Control System (ability to identify and correct cause of non-conforming work or work processes)

Contractor’s Safety Program (record of safe operation)

Project Manager (ability to effectively manage the contract)

Supervisors (ability to supervise contract work)

Contractor’s Work Staff, including Subcontractors (adequately trained; possess necessary skills; perform effectively in accordance with contract terms; etc.)

Timely contract start-up (acquired required licenses, training, administrative clearances, equipment, etc. and prepared to start performance by contract start date)

Timely performance of contract work

Timely performance of administrative actions (e.g. submission of required reports, records, and other data submissions)

Has the ability to respond to short-notice or no-notice emergencies.

Responsiveness to contract changes.

Ability to hire and retain a qualified workforce

1. Please discuss each response for which you indicated U (unsatisfactory) in response to the questions above (use additional sheets, if necessary).

2. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes____ Default____ Convenience____ Pending Terminations____ No ____

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having the contractor perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address:

Anthony Marshall

MICC-JBLM

Building 2015

JBLM, WA 98433-9500

Commercial: (253) 966-3495, DSN: 347-3495 FAX or E-mail to:

Fax No.: (253) 967-2772 Email: anthony.t.marshall.civ@mail.mil, Attn: Anthony Marshall mailto:anthony.t.marshall.civ@mail.mil