Attach 4 Past Performance Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

A. GENERAL INFORMATION:

Contractor’s Name: ____________________ Address: __________________________

Telephone Number: ____________________ __________________________

Fax Number: ____________________ __________________________

Point of Contact: ___________________________

Project Title or Brief 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 (Please correct any information above known to be inaccurate):

Name of Respondent: ___________________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5 6

NEUTRAL UNSATISFACTORY MARGINAL SATISFACTORY VERY

GOOD

EXCEPTIONAL

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

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 marginally effective.

Performance met contractual requirements.

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

Performan ce met all contract requireme nts and exceeded some to the governme nt’s benefit.

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

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

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

CONTRACTOR’S NAME: ________________________CONTRACT NUMBER_________________

The contractor:

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.

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.

12. Displayed initiative to solve problems.

13. Was responsive to contract changes.

14. Provided adequate project supervision.

15. Paid subcontractors/suppliers in a timely manner.

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

18. How would you rate the contractor's overall performance? 1 2 3 4 5 6

19.

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

YES/NO

20. Would you award another contract to this contractor? If not, explain in

“remarks.”

YES/NO

21. Is the contractor rated in CPARS? YES/NO

D. PLEASE PROVIDE ANY ADDITIONAL REMARKS TO ASSIST IN ACCURATE RATING OF

THE CONTRACTOR.

Remarks:

CONTRACTOR’S NAME: ________________________CONTRACT NUMBER_________________

E. EMAIL COMPLETED SURVEY FORM TO THE GOVERNMENT CONTRACT

SPECIALIST AT: michael.worth@columbus.af.mil with a copy to the Contracting Officer at betty.gill@columbus.af.mil or surveys may be faxed to 662-434-7753.

Signature of respondent: ___________________________

Printed/typed name: ____________________________

Title: ____________________________ mailto:michael.worth@columbus.af.mil mailto:betty.gill@columbus.af.mil