Attachment 5 - Past-Present Performance Survey.pdf

PAST PERFORMANCE SURVEY/QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

Address: Telephone Number:

Point of Contact:

Contractor Performed as the Prime Contractor, the Sub-Contractor.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

E-Mail:

C. FAX COMPLETED SURVEY FORM TO: 436 Contracting Squadron PKA

Attn:

Phone No.

OR

D. E-MAIL COMPLETED SURVEY FORM TO:

F. CONTRACT NO:

G. CONTRACT STATUS: (% complete, complete, just awarded, etc.)

H. AWARD AMOUNT:

I. TYPE OF CONTRACT:

H. PERFORMANCE PERIOD: From To

I. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS:

J. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation.

1 2 3 4 5 6

Unsatisfactory Marginal Non e

Satisfactory Very Good Exceptional

Performance did not meet most contractual requirements.

There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginall y effective.

No record of past performanc e or the record is inconclusiv e.

Performance met contract requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirement s and exceeded some to the government’ s benefit.

There were a few minor problems which the contractor resolved in a timely, effective manner.

Performance met all contract requirement s and exceeded many to the government’ s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner.

The contractor:

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

1 2 3 4 5 6 NA

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

1 2 3 4 5 6 NA

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

1 2 3 4 5 6 NA

4. Home office participated in solving significant local problems.

1 2 3 4 5 6 NA

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

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

1 2 3 4 5 6 NA

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

1 2 3 4 5 6 NA

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

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

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

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

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

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

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

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

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

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

1 2 3 4 5 6 NA

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

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6 NA

20. With respect to the safety plan, the contractor:

a. Followed the approved safety plan. 1 2 3 4 5 6 NA

b. Had no significant safety problems at the job site. 1 2 3 4 5 6 NA

21. The contractor met contractual requirements for the following work elements:

NA

a. Constructed pavements and drainage structures to the specified grade and alignment requirements

1 2 3 4 5 6 NA

b. Constructed pavement sections to the specified thickness, density, and surface smoothness requirements

1 2 3 4 5 6 NA

c. Performed specified curing and protection of concrete pavement surfaces

1 2 3 4 5 6 NA

d. Mobilized and completed work in a timely manner to work orders issued under the “On Call” or Indefinite Delivery Indefinite Quantity (IDIQ) contract

1 2 3 4 5 6 NA

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

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

Y E S

N O

24. Would you award another contract to this contractor? If not, explain in “remarks.”

Y E S

25. Has contractor demonstrated a history of environmental compliance with respect to erosion and sediment control on construction sites? If not, explain in “remarks.”

Y E S

Remarks: