Att_3_Perf_Questionnaire.pdf

FA4407-18-R-0007

PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE

A. GENERAL INFORMATION:

Offerors shall forward this attachment for completion to each contract reference the offeror wants the government to consider. Offerors shall ensure each respondent submits a completed questionnaire directly to the Contracting Officer by the closing date of the RFQ. Offerors are encouraged to have respondents submit the information prior to the closing date on the RFQ.

Contractor’s Name:______________________________________________

Project Title:____________________________________________________

Contract Number Assigned to the Contractor:__________________________

Contract Award Amount: $_____________ Contract Final Amount: $_______________

B. AGENCY INFORMATION:

Name of Respondent:_________________________ Title:_____________________________

Address:______________________________________________________________________

Telephone Number: _________________________________

Email Address:_____________________________________

C. PERFORMANCE INFORMATION:

Respondent shall include information below regarding the work performed. Use the Confident Rating table to complete this section.

Were you the prime contractor?_______ Subcontractor?_____ Joint Venture?_________

Ambulance, EMS and ALS Services □Yes □No

Report of Run Logs Received □Yes □No

What was the measured response time in minutes?_________________________

Number of unacceptable performance occurences: _________________________

1 2 3 4 5 6 None Little Unknown Satisfactory Significant High

Performance did not meet the contractual requirements.

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

Performance did not meet some of the contractual requirements. There were some problems, some of a serious nature, for which the corrective action was marginally effective

The record is inconclusive or without comment or the contractor did not perform this effort.

Performance met the contract requirements.

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

Performance met the contractual requirements and exceeded some requirements.

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

Performance met all of the contract requirements and exceeded many requirements.

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

Technical Expertise and Project Supervision 1 Contractor provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 N 3 4 5

2 Contractor hired and retained field workers with appropriate technical skills and training commensurate with those required for successful project completion.

1 2 N 3 4 5

3 Contractor delegated authority to project managers and supervisors commensurate with contract requirements.

Project manager’s role was clear.

1 2 N 3 4 5

4 Provided on-site superintendent at all times, or as otherwise required by the specific contract.

1 2 N 3 4 5

Home Office/On-Site/Government Interaction

5 Identified risks/problems as they occurred and offered constructive and/or viable solution/alternatives.

1 2 N 3 4 5

6 Contractor was responsive and reasonable to contract changes from the standpoint of timeliness, suggested solutions, and price.

1 2 N 3 4 5

7 Contractor displayed a cooperative attitude with company/government personnel before and after award.

1 2 N 3 4 5

8 Contractor’s on-site supervisor displayed initiative to resolve problems on-site.

1 2 N 3 4 5

9 Were there any claims by subcontractors/suppliers for non-payment. If yes, please explain outcome in “Remarks”.

YES NO

Project Specific Questions

10 N/A

1 2 N 3 4 5

Service Quality

11 Contractor provided and followed effective quality control plan and/or inspection procedures to meet contract requirements.

1 2 N 3 4 5

12 Contractor’s emphasis on delivering a quality service was apparent in day-to-day operations.

1 2 N 3 4 5

13 Contractor corrected deficiencies in a timely manner and pursuant to their quality control procedures.

14 Contractor maintained a quality workforce and subcontractors through project completion.

1 2 N 3 4 5

Schedule

15 Developed realistic progress schedules and met established project milestones.

16 Contractor provided the required Reports/Documentation as required in the contract.

Other

17 Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in "Remarks."

YES NO

18 Would you award another contract to this contractor? If not, explain in "Remarks."

YES NO

OVERALL ASSESSMENT

19 Overall, on the scale of 1 – 5, how would you rate the contractor being surveyed

Remarks: