Attch_4_-_Past_Performance_Questionnaire.pdf

FA2517-14-R-5001

PAST PERFORMANCE QUESTIONNAIRE

The below-named contractor/offeror is being considered for award of a contract for HVAC and Electrical Services at

Peterson Air Force Base, Colorado. A primary consideration in our selection process is the contractor’s history of performance of similar efforts. Please make every effort to be thorough in your answers/comments. Completed questionnaires can be returned via email or mail to the following:

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 &

3.104

EMAIL: Tracie.Winfree@us.af.mil and Andrew.Fallon.1@us.af.mil

MAIL: 21st Contracting Squadron/LGCAB

Attn: Tracie Winfree or Drew Fallon

Building 1324

580 Goodfellow St.

Peterson AFB, CO 80914-1648

A. GENERAL INFORMATION

Offeror’s Name:__________________________________________________________

Address: _______________________________________________________________

Telephone Number:_____________________ Point of Contact:____________________

B. RESPONDENT INFORMATION

Name:_________________________________ Title:___________________________

Organization & Address:___________________________________________________

Telephone: _______________ FAX:_______________ Email:____________________

C. CONTRACT INFORMATION

Contract Title:____________________________________________________________

Period of Performance:____________________ Contract Number:_________________

Dollar Amount of Contract:_________________________________________________

Services Performed:_______________________________________________________ mailto:Tracie.Winfree@us.af.mil mailto:Andrew.Fallon.1@us.af.mil

RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCE INFORMATION TO OFFEROR

SUBMITTING A PROPOSAL FOR THIS SOLICITATION.

D. PAST PERFORMANCE RELEVENCY

The Air Force will use the information below to determine how closely the Contractor’s past performance for the

Respondent matches the performance required for the Air Force. Please place an ‘X’ below all relevant service categories performed:

HVAC Type Work Commercial Chillers Boilers

For HVAC type work place an X in the appropriate boxes to the right

Electrical Type

Work

Commercial Generators Switch Gear Transformers Uninterrupted

Power Supply

(UPS)

For Electrical type work, place an X in the appropriate boxes to the right

Work Performed in

Secured Facility

Yes_______ No __________

Response Times required for service outages were less than one hour

Yes ______ No __________

Response Times required for service outages were less than two hours

Yes ______ No __________

E. PERFORMANCE INFORMATION

The Air Force will use your survey responses to determine a level of confidence, based on the offeror’s past performance record, concerning the offeror’s ability to successfully perform our requirement in accordance with the contract. Please assign one of the following ratings to each of the questioned areas listed below. The ratings selected will indicate the degree of doubt or confidence concerning performance in each area.

Rating Description

EXCELLENT (E)

The Offeror’s performance met contractual requirements and exceeded many requirements to the Respondent’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VERY GOOD (VG)

The Offeror’s performance met contractual requirements and exceeded some requirements to the Respondent’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

SATISFACTORY (S)

The Offeror’s performance met contractual requirements.

The contractual performance contained some minor problems for which corrective actions taken by the

Contractor appeared or were satisfactory.

MARGINAL (M)

The Offeror’s performance did not meet some contractual requirements. The contractual performance reflected a serious problem for which the contractor had not identified corrective actions or proposed actions appeared only marginally effective or were not fully implemented.

UNSATISFACTORY (U)

The Offeror’s performance did not meet most contractual requirements, and recovery was not in a timely manner. The contractual performance contained a problem(s) for which the contractor’s corrective actions appeared or were ineffective.

NOT APPLICABLE (N/A)

Not applicable or unknown. Did not observe performance in this area. No performance record is identifiable.

F. PEFORMANCE EVALUATION AREAS

Please use the above ratings and their assigned definitions to describe the offeror’s performance in the following areas:

1. QUALITY OF SERVICE *See Above for Rating Descriptions

a. Contractor’s overall quality and timeliness of customer service E VG S M U N/A

b. Contractor’s attention to detail E VG S M U N/A

c. Contractor’s willingness and effectiveness in correcting identified deficiencies

E VG S M U N/A

d. Contractor's ability to manage its workforce during fluctuating workloads

E VG S M U N/A

e. Contractor's ability to meet emergency, urgent, or routine timelines E VG S M U N/A

COMMENTS/REMARKS_______________________________________________________

2. MANAGEMENT AND RESPONSIVENESS *See Above for Rating Descriptions

a. Contractor provided experienced managers and supervisors with technical and administrative abilities to meet contract requirements

E VG S M U N/A

b. Contractor was responsive to work-order requests and completed work-orders within a reasonable timeframe

E VG S M U N/A

c. Contractor provided timely response to management deficiencies E VG S M U N/A

d. Contractor maintained sufficient levels of records (work-orders, serial numbers, warranties) and provided detailed reports to

Respondent when requested

e. Contractor’s overall management and responsiveness E VG S M U N/A

3. ACQUISITION AND STORAGE OF PARTS *See Above for Rating Descriptions

a. Contractor's ability to acquire, store, and use appropriate parts to meet customer needs

b. Contractor’s ability to procure and use high quality new or refurbished parts

E VG S M U N/A

c. Contractor’s ability to obtain parts at reasonable costs / prices E VG S M U N/A

d. Contractor’s ability to procure and replace parts in a timely manner E VG S M U N/A

e. Contractor's overall parts and storage compliance E VG S M U N/A

COMMENTS/REMARKS________________________________________________________

4. EMPLOYEES AND LICENSING *See Above for Rating Descriptions

a. Contractor maintained appropriate staffing levels

(number/qualifications)

E VG S M U N/A

b. Contractor employees were efficient with their time E VG S M U N/A

c. Contractor employees were sufficiently trained and informed E VG S M U N/A

d. Contractor used employees with appropriate levels of licensing to work on Electrical and/or HVAC equipment

E VG S M U N/A

e. Contractor provided copies of certifications and licensing in timely manner when requested

f. Contractor’s overall performance with employees and licensing E VG S M U N/A

5. If a government contract, did the contractor receive any Performance Assessment Reports, Letters of Concern, Negative Assessments, or Cure Notices?_____________ If yes, please describe:

6. If given the opportunity, would you award another contract to this contractor?_______

Please explain response below:

7. How would you rate the contractor’s overall performance? (Circle One) E VG S M U N/A

Signature of Respondent___________________________________ Date____________

Job Title:________________________________________________________________

Thank you for taking the time to complete this questionnaire.