PAST AND PRESENT PERFORMANCE EVALUATION QUESTIONNAIRE.docx

PAST AND PRESENT PERFORMANCE EVALUATION QUESTIONNAIRE

When filled in this document is Source Selection sensitive information IAW FAR 2.101 and 3.104

A. COMPANY INFORMATION:

1. Company/Division Name: _____________________________________________________

2. Telephone Number: _________________________________________________________

3. Address: _________________________________________________________________

4. Fax Number: ______________________________________________________________

5. Point of Contact: ___________________________________________________________

6. Program/Project Title (for similar projects performed within the last three (3) years)* ____________________________________________________________________________________________________________________________________________________________

7. Description of Program/Project (include frequency of scheduled pickups and approximate number pickup points/stops)*: _____________________________________________________

8. Contract Number Provided by Offeror: __________________________________________

9. Contract Dollar Value (including options) at award: ________________________________

10. Period of Performance (base year plus options/one (1) year requirement): _______________

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

* Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

The following information will assist our organization with the analysis of data. This information will not be released.

1. Contracting Agency/Company: ________________________________________________

2. Name of Respondent: _____________________________________________________

3. Title (i.e. Contract Administrator/COR/President/Management Assistant): ______________________________________________________________________________

4. Address: ______________________________________________________________

5. Telephone Number: ____________________________________________________

6. Fax Number: _________________________________________________________

7. Email Address: ____________________________________________________________

8. Length of involvement in project/contract: _____________________________________

9. Date Questionnaire was completed: _____________________________________________

C. FAX OR EMAIL COMPLETED SURVEY FORM TO:

FAX (618) 256-2174 or (618) 256-5237 jennifer.didgeon@us.af.mil or marcia.wuebbels@us.af.mil

DO NOT SEND COMPLETED QUESTIONNAIRE BACK TO

ORIGINATOR/REQUESTOR

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

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

Performance was not observed or not applicable to the current effort being reported against.

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

YES/NO

YES/NO

Remarks:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________