Attachment 3 - Past Performance Questionnaire.pdf

FOR OFFICIAL USE ONLY

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

FA441721Q0021

ATTACHMENT 3

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 1

SECTION A: CONTRACTOR INFORMATION

1. Contractor’s Name and Address:

2. Point of Contact:

3. Phone Number:

4. Contract Number: Contract Type:

5. Period of Performance:

SECTION B: RESPONDENT INFORMATION (To Be Completed By Evaluation Respondent)

1. Respondent’s Company Name & Address:

2. Respondent’s Name:

3. Phone Number: Fax Number:

E-Mail:

4. Award Amount: Final Amount:

5. Project Title: Project Number:

7. Period of Performance:

Start Date: End Date:

SECTION C: EMAIL COMPLETED QUESTIONNAIRE FORM TO:

6. Brief Project Description:

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

FA441721Q0021

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 2

Contract Specialist: Manivanh Mundy

Email: Manivanh.mundy@us.af.mil

Contracting Officer: Scott LeBlanc

Email: Scott.leblanc.3@us.af.mil

THIS FORM MUST BE RETURNED NO LATER THAN: The closing date and time of solicitation.

SECTION D: PERFORMANCE INFORMATION: Choose letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS.

E V S M U N

Exceptional (Outstanding)

Very Good (Above Average)

Satisfactory Marginal Unsatisfactory Not Available

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective meets contractual requirements. The contractual performance of the element or sub-element 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 of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions.

The Contractor’s proposed actions appear only marginally effective, or were not fully implemented does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective

No record of past performance or the record is inconclusive.

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

FA441721Q0021

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 3

1. QUALITY: Performance adhered to contract requirements.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

2. MANAGEMENT: Provided experienced, managers, and supervisors, with the technical and administrative abilities to meet requirements. Adequately coordinate and controlled performance of subcontractors. Identified problems as they occurred. Suggested approaches to resolving problems. Displayed initiative and cooperation in solving problems.

3. REGULATORY COMPLIANCE: Contractor complied with Financial, Environmental, Safety, and Reporting Requirements. Contractor was compliant with labor standards, posting of EEO, labor rates, minimum wage.

Payrolls were completed properly and received in a timely matter. No safety discrepancies were noted.

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

FA441721Q0021

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 4

4. RELIABILITY: Contractor provided all deliverables by the date and time established in the contract.

5. Based on the contractor’s overall performance, would you rehire this contractor? ☐YES ☐NO

OVERALL PERFORMANCE RATING:

Signature of Respondent: ________________________________________________________ Date: ________________