Attachment 4 - Past Performance Questionnaire.doc

DTFAAC-17-R-00106

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS FOR COMPLETING THE PAST PERFORMANCE QUESTIONNAIRE

Handwritten completion of this questionnaire is acceptable, if legible.

Include evaluation of contractor's performance based solely on the performance for which the contractor was/is liable. Please do not let factors beyond the control of the contractor which have resulted in performance delays or other problems bias the evaluation of the contractor's performance.

The following is a definition of the scoring system used:

4: Performance met/meets contractual requirements and exceeded/exceeds many to the Government’s/private entity’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

3: Performance met/meets contractual requirements and exceeded/exceeds some to the Government’s/private entity’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

2: Performance met/meets contractual requirements. The contractual performance of the area being assessed contains some minor problems for which corrective actions taken by the contractor appear to be or were satisfactory.

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

0: Performance did/does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

NA: Unable to provide an evaluation for this area/element.

In completing the questionnaire please circle a number corresponding to your rating.

Please provide clear and concise narrative explanations (both positive and negative) for your answers. This is especially important for any rating below a 2. If more space is needed than is provided, you may attach additional sheets.

Once the survey is completed, please e-mail your response to: kathleen.d.islas@faa.gov

PAST PERFORMANCE QUESTIONNAIRE

(To be completed by the Contracting Officer or the Contracting Officer’s Representative or equivalent)

I. CONTRACTOR/CONTRACT IDENTIFICATION.

A. Contractor (Company/Division):

B. Contract Number/Identification:

C. Description of Work and Location:

D. Period of Performance:

E. Contract Cost including options:

F. Number of full-time employees exclusively employed and managed:

G. Agency (Federal / State / Local Government or Private/Commercial):

H. Contract Type:

II. PAST PERFORMANCE/QUALITY EVALUATION:

1. Schedule - Assess the contractor’s timeliness and accuracy in submitting contract deliverables:

4 3 2 1 0 N/A Comments:

2. Quality of Direct Field Support - Assess the contractor’s conformance and success solving unique engineering problems while providing direct field support (e.g. good quality service, early problem identification, and effective corrective action). Direct field support is defined as providing technical consultation and assistance including “hands-on, on-site support” to field technicians and engineers when required to restore out of service NAS facilities, or equipment of similar complexity, back to operational status.

4 3 2 1 0 N/A Comments:

2. Quality of Overall Engineering Support - Assess the contractor’s conformance to contract requirements, specifications and standards of good workmanship in relation to overall engineering service (e.g., good quality deliverables and/or service, early problem identification, and effective corrective action):

4 3 2 1 0 N/A Comments:

4. Business Relations - Assess the integration and coordination of all activity needed to execute the contract, specifically the contractor’s history of reasonable and cooperative behavior and customer satisfaction.

4 3 2 1 0 N/A

Comments:

5. If you had a choice, would you use this company again? Yes No

RESPONDENT INFORMATION

[DO NOT RELEASE OUTSIDE OF THE GOVERNMENT – SOURCE SELECTION SENSITIVE DATA]

A. NAME OF EVALUATOR:

B. TITLE:

C. TELEPHONE NUMBER:

D. E-MAIL ADDRESS:

E. COMPANY/ORGANIZATION:

F. POSITION HELD IN REFERENCE TO THE CONTRACT

(Contracting Officer, COR or equivalent):

G. LENGTH OF INVOLVEMENT IN CONTRACT:

H. WAS THE OFFEROR GIVEN THE OPPORTUNITY TO RESPOND TO ALL

ADVERSE PAST PERFORMANCE INFORMATION? Yes No Not Applicable Unknown

Explain:

Signature

Date