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FA4528-25-Q-SP02
PAST PERFORMANCE QUESTIONNAIRE
A. GENERAL INFORMATION:
Contractor’s Name: Telephone : Address: Fax Number:
Point of Contact:
Submitting Survey as Prime or Sub-Contractor (please circle one) If submitting as Sub-Contractor, Prime Contractors Name: Address: Fax Number:
Point of Contact:
Project Title and Detailed Description of Work:
Contract Number Provided by Offeror: Dollar Amount:
Contract Period or Dates of Performance Provided by Offeror:
Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.
B. RESPONDENT INFORMATION:
Name and Title of Evaluator:
Company Name:
SOURCE SELECTION SENSITIVE IAW FAR 3.104 WHEN FILLED IN
| Address: | Telephone Number: |
| Fax Number: | Email Address: |
C. SEND COMPLETED SURVEY FORM TO:
Sherry L. Platt EMAIL: sherryplatt.1@us.af.mil DUTY PHONE: (701) 723-4180 D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Neutral |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective. |
| Performance meets contractual requirements with some to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective. |
| Performance meets contractual requirements. The contractual performance of the element or sub- element contains some minor problems for which corrective actions taken by the contractor were satisfactory. |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub- element being assessed 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. |
| Performance 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. |
| Performance was not observed or not applicable to the current effort being reported against. |
CONTRACTOR’S NAME: CONTRACT NUMBER:
Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.
Place an “X” in the appropriate column using the definitions matrix above.
| The contractor: |
| E |
| G |
| S |
| M |
| U |
| N |
| 1. |
| Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| 2. |
| Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period. |
| The contractor: |
| E |
| G |
| S |
| M |
| U |
| N |
| 3. |
| Delegated authority to project managers and supervisors commensurate with contract requirements. |
| 4. |
| Home office participated in solving significant local problems. |
| 5. |
| Followed approved quality control plan. |
| 6. |
| Provided effective quality control and/or inspection procedures to meet contract requirements. |
| 7. |
| Corrected deficiencies in timely manner and pursuant to their quality control procedures. |
| 8. |
| Provided timely resolution of contract discrepancies. |
| 9. |
| Identified problems as they occurred. |
| 10. |
| Suggested alternative approaches to problems. |
| 11. |
| Displayed initiative to solve problems. |
| 12. |
| Developed realistic progress schedules. |
| 13. |
| Met established project schedules. |
| 14. |
| Provided timely resolution of warranty defects. |
| 15. |
| Was responsive to contract changes. |
| 16. |
| Provided adequate project supervision. |
| 17. |
| Obtained consent of surety for increases in bonding as work-in- progress increased. |
| 18. |
| Paid subcontractors/suppliers in a timely manner. |
| 19. |
| Provided accurate and complete line item cost proposals including all aspects of work required for each task. |
| 20. |
| Cooperated with Government personnel after award. |
| 21. |
| How would you rate the contractor's overall performance? |
| 22. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
YES/NO
| 23. |
| Would you award another contract to this contractor? If not, explain in “remarks.” |
YES/NO
| 24. |
| Is the contractor rated in CPARS? |
| YES/NO |
CONTRACTOR’S NAME: CONTRACT NUMBER
Remarks: