Atch_5_-_PERFORMANCE_QUESTIONNAIRE.pdf

FA301619RA055

Attachment 5

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled in This Document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

Contractor’s Name: Address:

Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Period or Dates of Performance Provided by Contractor:

*NOTE: If the contractor holds or has held other contracts with your agency/organization in the last 3 years from the date of issuance of this solicitation, please complete separate evaluation forms for those contracts as well.

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

E-mail Address:

C. EMAIL COMPLETED SURVEY FORM TO: isadiri.estalilla@us.af.mil and lakeisha.gamble.2@us.af.mil.

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance quality. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY

QUALITY RATINGS OF 1 OR 2.

1 2 3 4 5

Not Applicable Unsatisfactory Marginal Satisfactory Very Good

Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance does not meet some contractual requirements. The contractual performance 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 meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Performance meets contractual requirements and exceeds some requirements to the

Government’s benefit.

The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

FA301619RA055

Attachment 5

THE CONTRACTOR:

Provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 3 4 5

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

1 2 3 4 5

Delegated authority to project managers and supervisors commensurate with contract requirements

1 2 3 4 5

4 Home office participated in solving significant local problems 1 2 3 4 5

5 Followed approved quality control plan 1 2 3 4 5

Provided effective quality control and/or inspections procedures to meet contract requirements.

1 2 3 4 5

Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5

8 Provided timely resolution of contract discrepancies 1 2 3 4 5

9 Identified problems as they occurred. 1 2 3 4 5

10 Suggested alternative approaches to problems 1 2 3 4 5

11 Displayed initiative to solve problems 1 2 3 4 5

12 Developed realistic progress schedules. 1 2 3 4 5

13 Met established project schedules 1 2 3 4 5

14 Provided timely resolution of warranty defects. 1 2 3 4 5

15 Was responsive to contract changes. 1 2 3 4 5

16 Provided adequate project supervision. 1 2 3 4 5

17 Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5

Provided accurate and complete line item cost proposals including all aspects of work required for each task

1 2 3 4 5

19 Cooperated with Government personnel after award 1 2 3 4 5

20 How would you rate the contractor’s overall performance? 1 2 3 4 5

Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain outcome in “remarks.”

YES / NO

22 Would you award another contract to this contractor? If not, explain in “remarks." YES / NO

23 Is the contractor rated in CPARS? YES / NO

CONTRACTOR’S NAME: CONTRACT NUMBER:

Remarks: