Attachment 5-ESC III Past Perf Questionnaire 2 Dec 11.docx

SOURCE SELECTION INFORMATION SEE FAR 2.101 AND 3.104

PERFORMANCE EVALUATION QUESTIONNAIRE

FA2521-12-R-0001

Attachment 5

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

(The offeror will enter this information…)

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.

(The respondent will enter this information…)

* 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: _____________________________

Length of involvement in the contract:

C. EMAIL COMPLETED SURVEY FORM TO: Scott Syring, Contracting Officer, at scott.syring@patrick.af.mil, and Candon Haynicz, Contract Specialist, at Candon.haynicz@patrick.af.mil.

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 E or G and M or U.(i.e. If the contractors overall rating is Exceptional please provide a narrative on what made them Exceptional.)

Performance meets contractual requirements 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.

Performance meets contractual requirements with 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.

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

Performance does not meet some 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.

Performance does not meet most 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.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

CERIFICATION REQUIREMENTS: ____________________________________________

WARRANTY REQUIREMENTS: ______________________________________________

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

TECHNICAL PERFORMANCE

For questions 1 through 6, please specify if the contract did not include the program or if the contractor did not perform each/all of these functions.

(1) Contractor’s ability to operate a compliant hazardous waste program base wide including a permitted hazardous waste facility, onsite accumulation sites, and transport of hazardous wastes, including all associated reports.

Narrative:

a. Was your hazardous waste program ever out of compliance?

b. If yes, describe the noncompliance:

c. What were the consequences regardless of contractor responsibility? (fine, letter of noncompliance, Notice of Violation, etc.):

d. How did the contractor resolve or assist in resolving the issue?

(2) Contractor’s ability to conduct environmental compliance sampling and analysis program as required by regulatory and permit requirements, including all associated reports.

Narrative:

Did contract include or did contractor perform the following:

a. Drinking water sampling and analysis

b. Wastewater sampling and analysis

c. Groundwater sampling and analysis

d. Stormwater sampling and analysis

e. Surface water sampling and analysis

f. Soil sampling and analysis

g. Air sampling and analysis

h. Other (specify) ____________________

(3) Contractor’s ability to ensure a compliant water program including drinking water, wastewater, stormwater, groundwater, surface water.

Narrative:

a. Was your water program ever out of compliance?

b. If yes, describe the noncompliance:

c. How did the contractor resolve or assist in resolving the issue?

(4) Contractor’s ability to ensure a compliant air quality program including Title V permitting, greenhouse gas and NESHAPs requirements.

Narrative:

a. Was your air quality program ever out of compliance?

b. If yes, describe the noncompliance:

c. What were the consequences regardless of contractor responsibility? (fine, letter of noncompliance, Notice of Violation, etc.):

d. How did the contractor resolve or assist in resolving the issue?

(5) Contractor’s ability to ensure a compliant petroleum storage tank/SPCC program including tank registrations, inspections, reporting requirements, and 24hr spill response (excluding cleanup).

Narrative:

a. Was your petroleum storage tank/SPCC/spill response program ever out of compliance?

b. If yes, describe the noncompliance:

c. What were the consequences regardless of contractor responsibility? (fine, letter of noncompliance, Notice of Violation, etc.):

d. How did the contractor resolve or assist in resolving the issue?

(6) Contractor’s ability to perform internal and support external environmental compliance inspection program including Air Force ESOHCAMP audits.

Narrative:

a. Were you satisfied with the contractor’s ability to identify and document findings?

b. Were you satisfied with the contractor’s follow-up actions to close out findings?

c. Were you satisfied with how the contractor conducted the environmental compliance audit (e.g., ESOHCAMP)?

d. Were these services performed as prime or sub contractor?

(7) Please rate the contractor's technical reports and other submittals on:

a. Content.

b. Accuracy

c. Timeliness.

Narrative:

(8) Please rate the contractor’s ability to:

a. Perform prescribed burns

b. Use certified personnel and proper equipment in performance of prescribed burns

c. Coordinate prescribed burns with regulatory and local agencies

Narrative:

(9) Please rate the contractor’s ability to:

a. Clear land

b. Utilize an air curtain incinerator or burn box to dispose of vegetation

Narrative:

(10) Please rate the contractor’s ability to:

a. Perform pesticide/herbicide applications

b. Use certified personnel for pesticide/herbicide applications

Narrative:

(11) Please rate the contractor’s ability to perform habitat restoration including exotic/invasive vegetation treatment/removal/control.

Narrative:

a. What types of habitat restoration did the contract include?

b. Does the contractor have experience treating/controlling/removing:

1. Brazilian Pepper

2. Cogon Grass

Narrative:

(12) Does the contractor have experience working in wetlands:

Narrative:

(13) Please rate the contractor's experience with threatened and endangered species, animal relocation and/or nuisance wildlife removal.

Narrative:

(14) Has contractor ever had experience working with the following species and/or improving their habitats:

a. Florida Scrub Jay

b. Sea Turtles

c. Beach Mouse

d. Gopher Tortoise

e. If answer is yes to any of the above, please expand and explain the level of effort for each activity.

Narrative:

Remarks:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Respondent’s Signature: _______________________________________

SOURCE SELECTION INFORMATION SEE FAR 2.101 AND 3.104