Rubber Removal Atch 1 Past and Present Performance.doc

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104 SUBJECT: Request for Past Performance Evaluation

TO:

Offeror complete below:

1. Contractor (Name, Address, and City/State/Zip code):

2. Point of Contact: ________________________________________

3. Telephone Number: _________________________ FAX Number: _________________________

4. Contract Number: ______________________________________

5. Program/Project Title: ________________________________________________

6. Type of Contract: Fixed Price ___ Cost Reimbursement ____ Other ____ (Explain)

7. Description, location, and relevancy of work. Also, provide references that demonstrate the quality of work performed for runway rubber removal.

8. Brief description of effort Prime ____ or Subcontractor ____.

9. Complexity of Work: Difficult _____ Routine _____

10. Performance Period: ____________________________________

11. Date of Award: ______________________________________

12. Original Contract Dollar Value: _____________________________

13. Current/Completed Contract Dollar Value: _________________________

14. If amounts for 12 and 13 above are different, provide a brief explanation for the reason.

15. Contract Completion Date (including extension): ___________________

16. Type and Extent of Subcontracting: ____________________________________________

17. Point of Contact Information:

a. Procuring Contracting Officer:

Name:

Address:

Fax:

Telephone Number: ____________________________

E-mail: _____________________________________

b. Administrative Contracting Officer (if applicable):

Name:

Telephone Number: ____________________________

E-mail: ____________________________________

c. Contracting Officer’s Representative:

Name:

Telephone Number: ________________________________

E-mail:

RESPONDENT/GOVERNMENT OFFICIAL’S INFORMATION AND PERFORMANCE EVALUATION

You have been provided as a reference in response to the solicitation for the Rubber Removal contract at Laughlin AFB. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to the 47th Contracting Squadron in accordance with the instructions listed below.

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgement of others within their organization, as applicable.

Offer/Bid Opening and Time: 2 May 2011, 4:30 P.M.

FAX to: (830) 298-4629 or DSN 732-4629 E-MAIL to: stephen.payne@laughlin.af.mil

Mail to:

47th Contracting Squadron/LGCB

Attn: Mr. Stephen A. Payne

171 Alabama Ave. Bldg 7

Laughlin AFB TX 78843-5102

POC:

TSgt Stephen A. Payne (830) 298-4629 or DSN 732-4629

1. Respondent/Government Official’s Information

Name:

Position/Title: _____________________________________________________

Telephone Number:

____________________Fax: _______________________

E-mail:

2. Relationship and time involved with Contractor:

3. Date questionnaire was completed: ________________________

The following chart depicts the RATINGS that are to be used to evaluate the contractor’s performance. Choose the number on the scale that most describes the contractor’s performance or situation.

Performance meets contractual requirements and exceeds many requirements to the Government’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.

CONTRACT WRITTEN BY: ____________________________________

CONTRACT NUMBER: _______________________________________

POINT OF CONTACT: ________________________________________

NAME OF PRIME CONTRACTOR: _____________________________

1. QUALITY CONTROL:

CIRCLE ONE

a. Provided quality of workmanship.

E G S M U N

b. Provided and followed effective Quality Control (QC) Plan.

E G S M U N

c. Provided effective inspection procedures to meet contract E G S M U N requirements.

d. Used materials specified.

E G S M U N

e. Ordered and used adequate materials.

E G S M U N

f. Completed punch-list items adequately.

E G S M U N

g. Provided adequate as-built drawings.

E G S M U N

h. Identified/corrected deficient work in a timely manner.

E G S M U N

i. Suggested solutions and displayed initiative to implement solutions.

E G S M U N

ADDITIONAL COMMENTS:

2. TIMELY PERFORMANCE:

CIRCLE ONE

a. Provided submittals in a timely manner.

E G S M U N

b. Developed and met realistic progress schedules.

E G S M U N

c. Resolved delays.

E G S M U N

d. Completed punch-list items timely.

E G S M U N

e. Completed work within performance period.

E G S M U N f The contractor provided all deliverables (including documentation) in a timely and accurate manner.

3. MANAGEMENT EFFECTIVENESS:

General Business Practices:

CIRCLE ONE

a. Provided experienced managers, and supervisors with the technical and administrative abilities needed to meet contract requirements.

b. Demonstrated ability to hire, maintain, and replace, if necessary, E G S M U N qualified personnel during the contract period.

c. Home office participated in solving significant local problems.

E G S M U N

d. Hired experienced subcontractors.

e. Paid subcontractors/suppliers in a timely manner.

f. Completed all contract work prior to requesting final inspection, left no major discrepancies.

g. Provided timely and satisfactory response to warranty issues after completion of project.

h. Cooperated to identify and resolve problems, attending meetings, E G S M U N

(as applicable) and maintained communication to assure satisfactory resolution.

i. Provided timely resolution of contract discrepancies.

E G S M U N

j. Obtained consent of surety for increases in bonding as work in progress increased.

k. Submitted proposals that accurately represent the work required.

E G S M U N

l. Site Manager ensured compliance with contract requirements and safety.

m. Site manager acted promptly to resolve problems and ensure work quality.

n. Delegated sufficient authority to Site Manager to make decisions or take actions during project performance.

o. Site manager consistently present on site when work was performed.

E G S M U N

p. Contractor’s overall Management Effectiveness.

ADDITIONAL COMMENTS: ___________________________________________________________

4. COMPLIANCE WITH LABOR STANDARDS:

a. Submitted payrolls in a timely manner.

E G S M U N

b. Completed payrolls correctly.

E G S M U N

c. Complied with labor laws and regulations with specific attention to the Davis-Bacon Act.

ADDITIONAL COMMENTS: ___________________________________________________________

5. COMPLIANCE WITH SAFETY STANDARDS:

a. Provided adequate safety plan.

E G S M U N

b. Implemented safety plan.

E G S M U N c Stored materials properly.

E G S M U N d Work performed in a safe manner.

E G S M U N e Overall safety rating.

6. CONTRACTUAL CONSIDERATIONS:

a. Assessment of liquidated damages (frequency, circumstances, severity (Yes No) of problem etc.).

b. Based on the contractor's overall performance, would this contractor be re-hired? If not, explain in “Additional Comments.”

c. Was the contractor cooperative in negotiating modifications so that they would result in fair and reasonable cost adjustments to the contract?

d. Have there been any labor disputes?

(Yes No)

e. Have there been any violations of federal, state, or local law?

(Yes No)

f. Have there been any indications that the contractor has had any financial difficulties?

(Yes No)

g. Contractor submitted modifications and other required proposals in a timely manner.

(Yes No)

h. Was the contractor ever issued a Cure or Show Cause Notice under the referenced (Yes No) contract? If yes, explain outcome in “Additional Comments.”

i. Is the contractor rated in CPARS?

7. COMPLIANCE WITH ENVIRONMENTAL LAWS: CIRCLE ONE

a. Complied with all federal, state, and local laws in waste disposal.

E G S M U N

b. Used at least the percentage amount of recovered materials in the E G S M U N performance of the contract required by the applicable contract specifications.

c. Complied with the required submittal of all Material Safety Data E G S M U N

Sheets (MSDS) on all hazardous materials used in contract performance.

d. Used EPA-designated products, using recovered materials to the E G S M U N maximum extent practicable without jeopardizing the intended end use of the item.

We would appreciate it if you could FAX your response back to us at Laughlin Air Force Base, TX.

FAX Number: (830) 298-4159

If you have any questions, please contact TSgt Stephen A. Payne, phone (830) 298-4629

THANK YOU FOR YOUR TIME AND QUICK RESPONSE.

Attachment 1

FA3099-11-R-0001