Past_Performance_Questionnaire.pdf

Attachment 4 27 July 2015

PAST/PRESENT PERFORMANCE

EVALUATION QUESTIONNAIRE

When addressing Past/Present Performance & Work Experience evaluation criteria set forth in SF 1442 of the solicitation, the offeror shall forward a copy of the questionnaire to the five (5) most recent references for whom the offeror has contracted similar services with the Federal, State, and Local Government or from private industry sources during the past five (5) years. The questionnaires must be forwarded to a verified point of contact at each of these agencies or business organizations for completion. Prior to forwarding the questionnaire to each reference, the offeror shall complete Section A (Contractor Information). Offerors are responsible for ensuring that their reference sources receive the questionnaires in time to complete and return the questionnaire to the 17th Contracting Flight, Base Infrastructure Flight prior to the proposal due date.

SECTION A: Contractor Information (to be completed by the contractor prior to mailing)

a. Contractor's name and address:

b. Point of Contact:

c. Phone No:

d. Contract Number: _________________________ Contract Type:

e. Project Title:

f. Period of Performance (include start & end dates):

g. Authorization is hereby granted to provide the information in SECTION B of this Questionnaire.

Signature of Authorized Representative Date

Printed Name & Title

SECTION B: RESPONDENT INFORMATION

(To be completed by Past/Present Performance & Work Experience Evaluation respondents)

a. Respondent's address:

b. Respondent's Name:

c. Phone No: _______________ Fax: _________________ Email

d. Contract Number: ________________________ Contract Type:

e. Award Amount: _________________________ Final Amount:

f. Project Title:

g. Period of Performance (Include start & end dates) :

Please mail the completed questionnaire to:

17 CONS/LGCA

Bldg 707 ATTN: SSgt Erick Shriver / SrA Sharon Krywinski San Angelo, Texas 76908-4705

Or e-mail to erick.shriver.1@us.af.mil and sharon.krywinski@us.af.mil

If you have any questions regarding this questionnaire, call SSgt Erick Shriver/SrA Sharon Krywinski via telephone (325) 654-4420 / (325) -654-4419

Performance Evaluation Instructions: When responding to the descriptive statements, select the letter, which most accurately describes the contractor's performance or situation. If the contractor has no record of past/present performance or work experience relevant to a particular question, select "Neutral".

E V S N M U Exceptional Very Good Satisfactory Neutral Marginal Un-satisfactory Based on the offeror’s performance record and work experience, essentially no doubt exists that the offeror will successfully perform the required effort

Based on the offeror’s performance record and work experience, little doubt exists that the offeror will successfully perform the required effort.

Based on the offeror’s performance record and work experience, some doubt exists that the offeror will successfully perform the required effort.

No performance record or known experience identifiable.

(see FAR 15.305 (a)(2)(iii) and (iv))

Based on the offeror’s performance record and work experience, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing process may be necessary in order to acheive contract requirements.

Based on the offeror’s performance record and work experience, extreme doubt exists that the offeror will successfully perform the required effort.

Evaluation of the Contractor's Performance:

I. Management/Personnel

1. Provided experienced managers and supervisors E V S N M U with the technical and administrative abilities to meet contract requirements

2. Demonstrated ability to hire, maintain, and replace, if E V S N M U necessary, qualified personnel during the contract period

3. All personnel were adequately trained E V S N M U

4. Required employee certifications were kept up to date E V S N M U

5. Delegated authority to project managers and supervisors E V S N M U commensurate with contract requirements

6. Provided adequate supervision E V S N M U

Management/Personnel Overall Performance Rating: E V S N M U

Respondent’s Comments (please provide comments to support rating above)

II. Quality Control

1. Followed approved quality control plan E V S N M U

2. Provided effective quality control and/or inspection E V S N M U procedures to meet contract requirments

3. Corrected defiencies in a timely manner and pursuant to the E V S N M U quality control procedures.

4. Provided timely resolution of contract discrepancies E V S N M U

5. Identified risks/problems as they occured E V S N M U

6. Displayed initiative to solve problems E V S N M U

Quality Control Overall Performance Rating: E V S N M U

III. Pricing

1. Contractor provided current, accurate, and complete E V S N M U proposals.

2. Contractor provided current, accurate, and complete E V S N M U billings.

3. Were there any contract changes, modifications, or terminations E V S N M U made due to the contractor’s failure to accurately estimate cost

4. The contractor’s supporting price/cost information for any E V S N M U modification was accurate, complete and reasonable (not over inflated or under estimated)

Pricing Overall Performance Rating: E V S N M U

IV. Quality Of Product

1. Met established schedules E V S N M U

2. Performed work that met or exceeded acceptable E V S N M U levels

3. Preventive/corrective maintaince was performed E V S N M U IAW the contract.

4. Were there any known safety problems experienced E V S N M U because of improper plant operations

5. Were there any known environmental problems E V S N M U experienced because of improper plant operations

Quality Of Product overall performance rating: E V S N M U

Other Considerations:

1. Contractor used care in treatment of government furnished YES NO property or other items provided to the contractor

2. Were cure notices, show cause letters ever issued YES NO (If "Yes", please briefly explain circumstatnces in comments section below)

3. Would you award another contract to this contractor (If “No”, please explain below)

Exceptional Very Good Satisfactory Neutral Marginal Unsatifactory Overall Rating Contractor Performance

Respondent’s Signature:__________________________________________

Date:_____________________