B.15 Attach 4 - PAST PERFORMANCE SURVEY

Attachment 4

PAST/PRESENT PERFORMANCE QUESTIONAIRE

SOLICITATION NO. FA4417-09-R-0014

FROM: 16th CONTRACTING SQUADRON/LGCB

HURLBURT FIELD, FL 32544

Contracting POC: TSG ROBERTO RODRIGUEZ-SANTIAGO

TELEPHONE #: (850) 884-1252

DSN: 579-1252

FAX #: (850) 884-1272

DSN: 579-1272

The Contractor, ___________________________(fill in with your company’s name) has offered the project listed as a reference for Solicitation No. FA4417-09-R-0014. Please complete the attached survey regarding the project. In accordance with FAR 15.306(e)(4), names of individuals providing reference information about an offeror’s past performance shall not be disclosed.

NOTE: Please correct any information below should it be inaccurate:

1. POINT OF CONTACT:

(Who we are to obtain information from)

2. Phone Number:

(Required)

3. FAX Number:

(Required)

4. Company (Org) Name:

5. Address:

6. Contract / Project #:

7. Description:

8. Performance Dates:

9. Initial Cost:

10. Final Cost:

11. Reason for Cost Changes:

URGENT! PLEASE RESPOND PROMPTLY

Company Name: ___________________________________________________

Solicitation Number: ________________________________________________ PERFORMANCE INFORMATION: When responding to the following statements, circle the number on the scale of 1 to 5, which most accurately describes the contractor’s performance. If the statement is not applicable circle N/A. The numbers 1 to 5 correspond to the following adjectives:

1. Developed realistic progress schedules and concluded the

1 2 3 4 5 N/A project within the established schedule.

COMMENTS/REMARKS: ______________________________________________________________

2. Provided experienced superintendent, managers, and supervisors, with

1 2 3 4 5 N/A the technical and administrative abilities to meet requirements.

COMMENTS/REMARKS: ______________________________________________________________

3. Adequately controlled performance of subcontractors.

COMMENTS/REMARKS: ______________________________________________________________

4. Provided effective quality control which resulted in a quality finished product.

COMMENTS/REMARKS: ______________________________________________________________

5. Provided submittals in a timely manner. Submittals were well researched and clearly identified the proposed item.

COMMENTS/REMARKS: ______________________________________________________________

6. Identified problems as they occurred. Suggested approaches to problems. Displayed initiative and cooperation to solve problems.

Provided adequate information and pricing for change orders and negotiated them in good faith.

COMMENTS/REMARKS: ______________________________________________________________

7. Provided timely resolution of punch list items and closeout documentation.

1 2 3 4 5 N/A

COMMENTS/REMARKS: ______________________________________________________________

8. Effectively worked with user during the design phase.

9. Provided design which met all of the project design critera.

10. Completed work matched the design.

11. Overall evaluation of the contractor.

PRINT NAME OF INDIVIDUAL WHO COMPLETED SURVEY

_______________________, COMMERCIAL #___________________

DSN #___________. PLEASE FAX COMPLETED QUESTIONNAIRE TO

TSgt Roberto Rodriguez-Santiago AT (850) 884-1272 OR DSN 579-1272*****

ATTACHMENT 4

ATTACHMENT 4