PAST_PERFORMANCE_QUESTIONAIRRE.docx

FA2860-13-R-0050

PAST PERFORMANCE QUESTIONAIRRE

22 August 2013

1) Contractor Identification:

a. Prime______ Sub_____ Cage Code____

b. Contract #__________________________________________

c. Contract Type______________________________________

d. Was this a sole-source contract? ________________________

e. Period of Performance________________________________

f. Initial contract cost:______________________________

g. Current/Final contract cost:____________________________

h. Reasons for difference in costs:

i. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

i. Service Description

i. ______________________________________

2) Customer/Agency Identification Customer Agency Name

a. _______________________

b. Customer description (as needed)__________________________________________________________________

3) Evaluator Identification

a. Name ______________________________________________

b. Title ___________________________________________________________________

c. Phone/Fax/E-mail_____________________________

PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, VG, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

RATING

DEFINITION

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

Performance meets contractual requirements and exceeds some requirements to the customer’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element being assessed contained some minor problems for which corrective actions taken by the contractor appear or was satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s 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 being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Place an X or check in the appropriate column using the definitions matrix above.

DO NOT SEND THE COMPLETED QUESTIONNAIRE TO THE CONTRACTOR.

Demonstrated ability to hire, maintain, and replace if necessary qualified personnel during the contract period.

Contractor effectively schedules work, ensuring sufficient and properly skilled manning is on hand to meet the requirements of the contract.

Contractor kept work area clean and disposed of all trash, inoperable components, and hardware after maintenance completion.

Contractor performed in accordance with manuals and technical guidelines recommended by the manufacturers.

Inoperable equipment was diagnosed, repaired, or replaced within a timely manner.

Was responsive to necessary contract changes.

If yes, please explain outcome in remarks

YES/NO

If not, please explain in remarks

YES/NO

1. During the course of the contract, was notification sent to the contractor identifying unsatisfactory work.

2. Please provide a narrative explanation for any ratings of M or U. Positive comments for S, VG and E ratings are also welcome.

3. Government Contracts only: Has this contract been partially or completely terminated for defaults/convenience or are there any pending terminations?

Evaluators Signature/Date

Please return this completed questionnaire to:

E-mail: christopher.castro@afncr.af.mil Contact Number: 240-612-5661