Attachment 17(C) - Past Perf Quest. (Sec J Attach).C

ATTACHMENT 17(R)

SIR/RFO DTFAAC-15-R-02838

PAST PERFORMANCE QUESTIONNAIRE

1. Please complete this questionnaire based on the following guidance:

a. Handwritten responses are acceptable.

b. Indicate, based on the ratings below, the contractor’s performance on the identified program. Assessments should reflect only performance for which contractor is/was responsible. The following is a definition of the rating levels:

RATING

PERFORMANCE LEVEL

4 EXCELLENT: Performance meets contractual requirements and exceeds many requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

3 GOOD: Performance meets contractual requirements and exceeds some requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

2 SATISFACTORY: Performance meets contractual requirements. The contractual performance of the factors contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

1 MARGINAL: Performance does not meet some contractual requirements. The contractual performance of the factors being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

0 UNSATISFACTORY: Performance does not meet most contractual requirements and corrections are not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

c. Please circle (or underline for e-mailed responses) a “Number” or “Yes” / “No” corresponding to your rating or “N/A” if you are unable to provide a rating for an area.

d. PLEASE PROVIDE NARRATIVE EXPLANATIONS FOR ANY MARGINAL, POOR OR “YES” RATINGS. SPACE FOR YOUR NARRATIVE REMARKS IS PROVIDED ON THE LAST PAGE OF THE QUESTIONNAIRE. IF MORE SPACE IS NEEDED, USE THE BACK OF THE QUESTIONNAIRE.

e. You are urged to supplement your own knowledge of the contractor’s performance with judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other similar programs for which your activity has contracts with this offeror.

2.

Please return completed questionnaire by e-mail to the following:

Kathleen Islas, Contracting Officer (AAQ-720)

Phone: (405) 954-8534 e-mail: kathleen.d.islas@faa.gov

DTFAAC-15-R-02838

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

The company who provided this questionnaire is proposing on a Federal Aviation Administration (FAA) Power Systems Installation contract. Past performance is of considerable importance to this Source Selection. Therefore, input from current or previous customers of the offeror is very important.

We would greatly appreciate you taking the time to complete this form. Please provide an honest assessment and immediately return not later than May 01, 2015 to the following point of contact:

FAA

Attn: Kathleen Islas, Contracting Officer

Phone: (405) 954-8534 kathleen.d.islas@faa.gov If you have any questions, please contact Ms. Kathleen Islas at (405) 954-8534.

PART TWO: GENERAL INFORMATION

A. CONTRACTOR:

POINT OF CONTACT:

TITLE:

TELEPHONE NO.:

E-MAIL:

B. CONTRACT NUMBER:

CONTRACT TYPE:

PERIOD OF PERFORMANCE:

APPROXIMATE DOLLAR VALUE:

CONTRACT DESCRIPTION:

If performance involved one or more of the following, please mark all that apply:

Program Management _____

Engineering Services ______

Installation Services

Engine Generator(s) ______

Uninterruptible Power Supply(s) ______

Electrical Distribution Equipment ______

Fuel Tank(s) ______

Underground High Voltage Cable ______

Installation of electrical power equipment at critical power facilities ______

Other:

PART THREE: QUESTIONS

The numbers 0 to 4 correspond with the following descriptive values provided on the questionnaire cover page:

Unsatisfactory Marginal Satisfactory Good Excellent

A. PROGRAM MANAGEMENT

a. If so, please explain? ___________________________

Yes or No

a. If so, for what? ________________________________

b. What corrective action did the contractor take to correct the situation? __________________________________

Yes or No

If so, why? _________________________________________

Yes or No

B. ENGINEERING

Did the contractor provide a Statement-of Work?

If so, what extent was it relevant?

0 1 2 3 4 N/A

Yes or No 0 1 2 3 4 N/A

If so, what extent was it relevant?

Yes or No

0 1 2 3 4 N/A

C. INSTALLATION

a) Tracking equipment shipments and arranging delivery.

b) Coordinating permits and approvals from Federal, State and local authorities having jurisdiction over the projects Scope-of-Work.

c) Obtaining qualified subcontractors, such as licensed electricians and fuel tank installers.

d) Completing As-built drawings.

e) Resolving the final inspection discrepancy list.

0 1 2 3 4 N/A

0 1 2 3 4 N/A

0 1 2 3 4 N/A

0 1 2 3 4 N/A

0 1 2 3 4 N/A

If not, why? _________________________________________

Yes or No

If so, why? __________________________________________

Yes or No

D. Is there anyone to whom you recommend we send this survey? If so, please provide their name, organization and telephone number.

NAME: _________________________________________

ORGANIZATION: __________________________________

TELEPHONE NO.: _________________________________

E. Would you recommend award of a similar contract to this contractor? Yes or No F. Remarks: _______________________________________________________________

PART FOUR: RESPONDENT INFORMATION

The following information will assist in the analysis of the data provided. Information will be kept CONFIDENTIAL:

NAME OF RESPONDENT: _____________________________________

POSITION TITLE: ____________________________________________

ORGANIZATION: _____________________________________________

TELEPHONE NO.: ____________________________________________

LENGTH OF INVOLVEMENT IN PROGRAM/CONTRACT: ______________

DATE QUESTIONNAIRE COMPLETED: ____________________________

THANK YOU!