7_Past_Performance_Questionaire_Attachment_5.pdf

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

Contractor’s Name: ____________________ Address: __________________________ Telephone Number: ____________________ __________________________ Fax Number: ____________________ __________________________ Point of Contact: ____________________

Project Title or Brief Description of Work:_______________________________________________

Contract Number Provided by Offeror: Dollar Amount: $ ________*

Contract Period or Dates of Performance Provided by Offeror: __________________________*

*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.

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

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: _____________________ _____________________________ Email Address: _____________________

C. FAX COMPLETED SURVEY FORM TO: ____________________________________

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

EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5

NO CONFIDENCE LIMITED

CONFIDENCE

SATISFACTORY

CONFIDENCE

SUBSTANTIAL

CONFIDENCE

UNKNOWN

CONFIDENCE

Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort

Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort.i

No performance record is identifiable.ii

FA3030-13-R-0001

Attachment #5

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER________________

The contractor:

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

1 2 3 4 5

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

1 2 3 4 5

3. 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

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

1 2 3 4 5

7. 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. Met established project schedules. 1 2 3 4 5

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

14. Provided adequate project supervision. 1 2 3 4 5

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

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

1 2 3 4 5

17. Cooperated with Government personnel after award. 1 2 3 4 5

18. How would you rate the contractor's overall performance? 1 2 3 4 5

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

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

21. Is the contractor rated in CPARS?

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER_______________

Remarks:______________________________________________________________________________

FA3030-13-R-0001

Attachment #5