Attachment 6 - Past and Present Performance Questionaire - FA2521-R-10-1002 _dtd 8 Oct - 3 Pages_.pdf

FOR OFFICIAL USE ONLY (WHEN FILLED OUT)

8 Oct 2010

APPENDIX I FOR OFFICIAL USE ONLY (WHEN FILLED OUT)

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

FA2521-10-R-1002

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ___________________________ Telephone Number: ____________________ Address: ___________________________________ Fax Number: _________________________ ___________________________________ Point of Contact: ______________________

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and 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.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: ___________________________ Title: _________________________________

Address: ____________________________ Telephone Number: _____________________

___________________________________ Fax Number: __________________________

___________________________________ Email Address: _________________________

C. FAX COMPLETED SURVEY FORM TO: Linda Brantley, Contracting Officer at (321) 494-6193

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements

Performance meets contractual requirements with

Performance meets contractual requirements. The

Performance does not meet some

Performance does not meet most

Performance was not observed or not with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

contractual requirements.

The contractual performance of the element or sub-element 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.

contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

applicable to the current effort being reported against.

CONTRACTOR’S NAME: __________________________ CONTRACT NUMBER: _______________________ Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

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. Compliance with Service Contract Act, Davis-Bacon Act and EEO requirements to include Payrolls properly completed and submitted

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.

The contractor: E G S M U N

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules and stay on schedule .

13. Completion of punch-list items.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Adequacy of site clean up- all work and storage areas are cleaned and secured at end of each day

17. Effectiveness of jobsite supervision – site is safe and secure, clear line of supervision.

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

19. Paid subcontractors/suppliers in a timely manner.

20. Use of Specified Materials – contractor used specified or equal material or products

21. Cooperated with Government personnel after award.

22. How would you rate the contractor's overall performance?

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

YES/NO

24. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

25. Is the contractor rated in CCASS? YES/NO

CONTRACTOR’S NAME: __________________________ CONTRACT NUMBER _____________________

Remarks:_____________________________________________________________________________________