Attachment 4 - Past Performance Questionnaire Official Release.pdf

FA301620U0126

Attachment 4

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled in This Document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

Address: Contractor’s Name:

Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Period or Dates of Performance Provided by Quoter:

*NOTE: If quoter 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.

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

E-mail Address:

C. EMAIL COMPLETED SURVEY FORM TO: patrick.thielemann@us.af.mil and marcus.mattingly@us.af.mil.

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXMPLANATION FOR ANY

RATINGS OF 1 OR 2.

1 2 3 4 5 6

NO

CONFIDENCE

LITTLE

CONFIDENCE

UNKNOWN

CONFIDENCE

SATISFACTORY

CONFIDENCE

SIGNIFICANT

CONFIDENCE

HIGH

CONFIDENCE

Based on the quoter’s performance record, extreme doubt exists that the quoter will successfully perform the required effort.

Based on the quoter’s performance record, substantial doubt exists that the quoter will successfully perform the required effort.

NO performance record is identifiable

Based on the quoter’s performance record, the government has confidence the quoter will successfully perform the required effort.

Normal contractor emphasis should preclude any problems.

Based on the quoter’s performance record the government has significant confidence the quoter will successfully perform the required effort.

Based on the quoter’s performance record, the government has high confidence the quoter will successfully perform the required effort.

FA301620U0126

Attachment 4

CONTRACTOR’S NAME: CONTRACT NUMBER:

THE CONTRACTOR:

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

1 2 3 4 5 6

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

1 2 3 4 5 6

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

1 2 3 4 5 6

4. Home office participated in solving significant local problems 1 2 3 4 5 6

5. Followed approved quality control plan 1 2 3 4 5 6

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

1 2 3 4 5 6

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

1 2 3 4 5 6

8. Provided timely resolution of contract discrepancies 1 2 3 4 5 6

9. Identified problems as they occurred. 1 2 3 4 5 6

10. Suggested alternative approaches to problems 1 2 3 4 5 6

11. Displayed initiative to solve problems 1 2 3 4 5 6

12. Developed realistic progress schedules. 1 2 3 4 5 6

13. Met established project schedules 1 2 3 4 5 6

14. Provided timely resolution of warranty defects. 1 2 3 4 5 6

15. Was responsive to contract changes. 1 2 3 4 5 6

16. Provided adequate project supervision. 1 2 3 4 5 6

17. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6

18. Provided accurate and complete line item cost proposals including all aspects of work required for each task 1 2 3 4 5 6

19. Cooperated with Government personnel after award 1 2 3 4 5 6

20. How would you rate the contractor’s overall performance? 1 2 3 4 5 6

21. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

1 2 3 4 5 6

22. Would you award another contract to this contractor? If not, explain in “remarks." YES / NO

23. Is the contractor rated in CPARS? YES / NO

CONTRACTOR’S NAME: CONTRACT NUMBER:

Remarks:

When Filled in This Document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104