Attachment 4 - Past Performance Questionnaire.doc

PAST PERFORMANCE QUESTIONNAIRE

Contractor Being Evaluated:

(If Applicable) Teaming with:

I.

Background. The purpose of this questionnaire is to obtain past performance information relative to contracts that have previously been completed or are currently being performed by the contractor identified above. This company is a potential source for performing a Firm Fixed Price contract.

II.

Instructions. Please complete the questionnaire based on the following guidance:

A.

Handwritten responses are sufficient.

B.

Indicate, based on the description below, the contractor's performance on the identified program in the assessment area. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

Code

Performance Level

E

EXCEPTIONAL – The contractor's performance meets contractual requirements and exceeds many requirements.

VG

VERY GOOD – The contractor's performance meets contractual requirements and exceeds some requirements.

S

SATISFACTORY – No problems exist or only minor problems for which solutions are in hand.

M

MARGINAL – Problems exist for which there is doubt whether the identified solution is adequate but the problem appears to be within the contractor's ability to solve.

U

UNSATISFACTORY – Serious problems exist which may be outside the contractor's ability to solve. The contractor is in danger of not being able to satisfy contractual requirements and timely recovery is not likely.

N

NOT APPLICABLE – Unable to provide a score.

[Circle the word corresponding to your rating.]

C.

Please provide comments for all questions in which an Unsatisfactory, Satisfactory, or Marginal rating is given and as appropriate for all other answers. Space for your comments is provided in each area. If more space is needed, attach additional sheets to the end of the questionnaire and reference the respective questions.

D.

You are urged to supplement your own knowledge of the offeror's performance with the judgment of others in your organization. In addition to completing the attached questionnaire for the program, we solicit your comments on other similar programs for which your office has contracts with this offeror:

ATTN: Micheal S. Scott

17 CONS/PKA

210 Scherz Blvd

Goodfellow AFB, TX 76908-4705

Commercial FAX: (325) 654-5149 DSN FAX: 477-5149

Commercial Voice: (325) 654-4547 DSN Voice: 477-4547

YOUR ASSISTANCE IN EVALUATING THE CONTRACTOR'S PAST PERFORMANCE IS

APPRECIATED. OUR GOAL IS TO SELECT THE BEST VALUE TO THE GOVERN-MENT. YOUR PAST PERFORMANCE EVALUATION IS A CONSIDERATION IN

DETERMINING THE BEST VALUE.

III. Program Identification. Evaluator, please complete:

A.

Contractor Being Evaluated: __ ________________________________________

B.

Contract Number: __ ________________________________________________

C.

Estimated Contract Dollar Amount: ___

D.

Dates of Contract Performance: ___

E.

Describe Contract: __ F.

Contract Type: ___________________________________________________

IV. Past Performance Evaluation.

1.

Overall performance in planning and managing the contract project?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Comments: ___ _________________________________________________________

2. How well did the contractor's on-site management/superintendent control overall quality?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Comments: ____

3. How well did the contractor manage subcontractors?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Comments:

4. How well did the contractor adhere to the contract schedule?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Comments: ____

5. How well did the contractor comply with contract terms and conditions?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

Comments: _____

6. Were any cure or delinquency notices issued? If so, explain the situation.

Comments: __ _______________________________________________________________

7. Were there any modification? If so, provide a brief description.

Comments: __ __________________________________

8. Would you enter into another contract with this contractor?

Comments:___

V.

Respondent Information. The following information will assist in the analysis of the data, and will be kept confidential.

A.

Name of Evaluator: __

B.

Office Symbol/Location: _______________________________________

C.

Phone (Commercial/DSN)____

D.

Position Title/Grade: __

E.

Length of Time on Program/Contract: __

F.

Date Questionnaire Completed: ___ ______________________