Attachment 6 - Past Performance Questionaire.docx

ATTACHMENT 7, PAST PERFORMANCE QUESTIONNAIRE

In accordance with FAR 2.101 and 3.104, this document is considered source selection information once filled in.

Offeror: Complete through Part I, and then send the questionnaire to the primary customer point of contact most familiar with the performance effort.

Primary Customer: Complete Part II and Part III The below-named contractor is being considered for award of a contract for Solicitation No. FA487720R0047 at Davis-Monthan AFB AZ. A primary consideration in our selection process is the contractor’s history of performance of similar efforts. The scope of work includes, but is not limited to: relamp apron lighting with LED. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space, please attach an additional page(s). If you have any questions, please call the Contract Administrator, 2d Lt Samantha Durlauf at (520) 228-5476. Please email the completed questionnaire to: samantha.durlauf@us.af.mil and mathew.st_thomas@us.af.mil.

ATTACHMENT 6

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: Contract No.:

Subcontract No. (if applicable):

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Outstanding: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division: Address:

Program Identification/Title: Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above): Contract Award Date:

Forecasted or Actual Contract Completion Date: Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number: Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) A. QUALITY - Assess the Contractor's conformance to contract or order requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).

___ Outstanding (Explanation must be provided in Comments field below) ___ Good ___ Acceptable ___ Marginal (Explanation must be provided in Comments field below) ___ Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

B. SCHEDULE - Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance).

___ Acceptable ___ Marginal (Explanation must be provided in Comments field below) ___ Unsatisfactory (Explanation must be provided in Comments field below)

C. MANAGEMENT - Assess the integration and coordination of all activity needed to execute the contract or order, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the Contractor's history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts.

___ Acceptable ___ Marginal (Explanation must be provided in Comments field below) ___ Unsatisfactory (Explanation must be provided in Comments field below)

D. REGULATORY COMPLIANCE - Consider aspects of performance such as compliance with financial, environmental (example: Clean Air Act, Clean Water Act), safety, and labor regulations as well as any other reporting requirements in the contract terms and conditions.

___ Acceptable ___ Marginal (Explanation must be provided in Comments field below) ___ Unsatisfactory (Explanation must be provided in Comments field below)

E. General Comments. Provide any other relevant performance information.

F. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

G. Respondent Identification. Please provide the following information:

Organization: Name:

Title: Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN

INFORMATION Please return this completed Questionnaire via e-mail to the 355 CONS Office, samantha.durlauf@us.af.mil. Thank you for your assistance.

Signature Date

Typed or Printed Name

1. Contract Number Award Date Contract type

2. Completion Date/Delivery Schedule.

Original completion/delivery date Revised completion/delivery date

3. Price/Cost – original awarded price

4. Modified Price/Cost -

5. Completion Date or Delivery Schedule – original AND final (or projected final, if the contract is current).

6. Changed Dates -

7. Contact Information - Address and telephone number for the Government (or commercial) procuring contracting activity AND contract administrative activity (if applicable). Name, telephone number, fax number and e-mail address for the following:

8. Procuring Contracting Officer (PCO).

Address: Phone Number: Fax Number: E-Mail Address:

9. Administrative Contracting Officer (ACO).

Address: Phone Number: Fax Number: E-Mail Address:

10. Government or commercial technical representative or COR.

Address: Phone Number: Fax Number: E-Mail Address:

11. Relevancy Description.

12. Narrative explanation.

13. Negative Performance Documentation.