Attachment 5 Past Performance Questionnaire.pdf

Attachment 5 - PAST PERFORMANCE QUESTIONNAIRE

This attachment requires input from your provided Reference. Please ensure block 5-8 are completed by the Reference. This attachment can be sent directly to the Government by the Reference to BulkFuelsBidCustodian@dla.mil prior to the closing date of this solicitation. The subject line of the email correspondence must specify the solicitation number and the Offeror name to which this attachment is being submitted.

CONTRACT INFORMATION (Offeror to complete blocks 1-4)

1. Contractor Information:

CONTRACTOR NAME: CCR CAGE CODE:

ADDRESS: CCR DUNs NUMBER:

PHONE NUMBER:

EMAIL ADDRESS:

POINT OF CONTACT: CONTACT PHONE NUMBER:

2. Work Performed as: ______ Prime Contractor ______ Sub Contractor ______ Join Venture ______ Other (Explain)

If subcontractor, who was the prime (Name/Phone#):

3. Contract Information

Contract Number:

Contract Type: _________ Firm Fixed Price __________ Cost Reimbursement _________ Other (Please specify):

Contract Title:

mailto:BulkFuelsBidCustodian@dla.mil

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Contract Description:

Complexity of Work: ________ High ________ Med _________ Routine

How is this contract relevant to the requirement of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Reference to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the reference’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

Attachment 5 - PAST PERFORMANCE QUESTIONNAIRE Continued

The following questions require you to circle whether the answer is “YES” or “NO”. If the question is not applicable, circle “N/A”. If the question is answered as “NO”, please provide an explanatory narrative. These narratives need not be lengthy, just descriptive. Space for narrative comments is included after each question and in the “Remarks” page of the survey. If more space is needed attach additional pages. You do not need to write a narrative for any questions answered as “YES” unless the question requests you to provide an explanation.

SCHEDULE

01. Was the Contractor responsive and timely in providing the required services?

YES NO

N/A

02. Was the Contractor responsive and timely to administrative functions of the contract?

03. Was the Contractor responsive and timely responding to questions or correspondence?

04. Was the Contractor in compliance with contract terms and conditions?

05. Were any contract concessions/changes/terminations made due to the contractor’s failure to accurately plan? (If you answered “YES”, please provide an explanation).

MANAGEMENT OF KEY PERSONNEL

06. Did the Contractor appropriately prepare & train the personnel? YES NO

07. Did the Contractor effectively manage subordinates? YES NO

QUALITY OF SERVICES

08. Did the Contractor assimilate & accommodate changes in contractual requirements and/or priority effectively?

09. Did the Contractor exhibit knowledge of and comply with

Government (or other) regulations?

10. Did the Contractor demonstrate technical expertise in providing all contractual services?

11. Did the Contractor possess/utilize tools/equipment necessary to adequately provide the required services?

QUALITY OF SERVICES (CONTINUED)

12. Did the Contractor meet the standard for:

(a) Technical Performance? YES NO

N/A

(b) Administrative Performance? YES NO

N/A

(c) Safety & Health? YES NO

13. Has the Contractor ever failed to effectively control the quality of services provided? (If you answered “YES”, please provide an explanation).

14. Has a Contract Discrepancy Report (or equivalent) ever been issued? (If you answered “YES”, please provide an explanation).

15. Has a Cure Notice or Show Cause Letter ever been issued? (If you answered “YES”, please provide an explanation).

16. Have there been any disputes/claims relative to the contract? (If you answered “YES”, please provide an explanation).

17. Has the Contractor demonstrated the ability to correct any of the problems for questions 14 through 16? (If you answered “YES”, please provide an explanation).

QUALITY OF SERVICES (CONTINUED)

18. Has the contract been terminated for default? YES NO

19. Has an election ever been made to not exercise an option due to the Contractor’s poor performance? (If you answered “YES”, please provide an explanation).

BUSINESS RELATIONS

20. Did the Contractor satisfactorily manage subcontracts? YES NO

21. Have there been any labor disputes? (If you answered “YES”, please provide an explanation).

22. Have there been any violations of Public Law, especially the

Service Contract Act? (If you answered “YES”, please provide an explanation).

23. Did the Contractor consistently provide prompt and courteous service?

BUSINESS RELATIONS (CONTINUED)

24. Did the Contractor promptly and courteously resolve customer complaints?

25. Did the Contractor’s actions show an overall commitment to customer satisfaction?

26. Did the Contractor satisfactorily provide overall cooperation relative to this contract?

YES NO

N/A

27. How would you rate the integration and coordination of all activity needed to perform this contract?

YES NO

N/A

28. Did you feel that the Contractor’s overall performance was satisfactory?

YES NO

N/A

29. Would you award similar contracts to this Contractor? YES NO N/A

REMARKS:

Please use this space if you needed more room than provided under the question. Label the remark with the applicable question number that it relates to.

Please list other known references regarding the Contractor’s performance:

TELEPHONE/

NAME ADDRESS FAX

NUMBERS