161006_FA3099-16-R-0010 _Atch_11 _Past_Performance_Survey.pdf

FA3099-16-R-0010

Attachment 11

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

SUBJECT: Request for Past Performance Evaluation

You have been provided as a reference in response to the solicitation for a Packing &

Crating contract for the preparation of personal property of Department of Defense personnel for shipment and/or storage and related services through the DPM. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to the 47th Contracting Squadron in accordance with the instructions listed below.

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

Questionnaires shall be sent directly back to the Government.

FAX to: (830) 298-4178 or DSN 732-4178

E-MAIL to: curtis.williams.22@us.af.mil or garret.parker@us.af.mil

Mail to: 47th Contracting Squadron/LGCA

Attn: Curtis Williams / Garret Parker

171 Alabama Ave. Bldg 7

Laughlin AFB TX 78843-5102

POC: Curtis Williams (830) 298-5768 or DSN 732-5768

Garret Parker (830) 298-5715 or DSN 732-5715

1. Respondent/Government Official’s Information

NAME:__________________________________________________________

POSITION/TITLE:__________________________________________________

ADDRESS:________________________________________________________

TELEPHONE

NUMBER__________________FAX_______________________________________

EMAIL_________________________________________________________________

2. Relationship and time involved with Contractor:

mailto:curtis.williams.22@us.af.mil mailto:garret.parker@us.af.mil

3. Date questionnaire was completed:

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: _____________________

____________________________________ E-Mail Address:___________________

C.FAX COMPLETED SURVEY FORM TO THE GOVERNMENT AT:

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 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 6

UNSATISFAC

TORY

MARGINA

L

SATISFACT

ORY

VERY

GOOD

EXCEPTI

ONAL

NEUTRAL

Performance did not meet most contractual requirements.

There were serious problems and the contractor’s corrective actions were ineffective.

Performanc e did not meet some contractual requirement

s. There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance met contractual requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’ s benefit.

There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performanc e met all contract requiremen ts and exceeded many to the governmen t’s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner.

No record of past performanc e or the record is inconclusiv e.i

The contractor:

1. Met established pick-up/delivery schedules. 1 2 3 4 5 6

2. Provided experienced managers, and supervisors, with the technical and administrative abilities needed to meet contractual requirements. Demonstrated ability to replace personnel if necessary, without project delays

1 2 3 4 5 6

3. Provided effective quality control, which resulted in a quality, finished product.

1 2 3 4 5 6

4. Identified problems as they occurred. Suggested solutions to problems. Displayed initiative to solve problems. Provided adequate information and pricing for modifications.

5. Delivered household goods free of visible dirt, debris, dampness, odor, mildew, cleaning chemical residue, and properly packaged.

1 2 3 4 5 6

6. Made complete deliveries of household goods on delivery dates.

1 2 3 4 5 6

7. Did the contractor have vehicles of the correct type and size to support moves.

1 2 3 4 5 6

8. Did the contractor supply the correct amount of vehicles to support moves.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Cooperated with Government personnel after award. 1 2 3 4 5 6

12. How would you rate the contractor's overall performance?

1 2 3 4 5 6

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

YES/N

O

14. Is the contractor rated in CPARS? YES/N

O

Remarks:________________________________________________________________ iCONTRACTOR’S NAME: _____________________________

CONTRACT NUMBER________________________________