Attachment_4_-_Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION SENSITIVE – SEE FAR 3.104

ATTACHMENT 4

FA4417-13-R-0004

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

SECTION A: CONTRACTOR INFORMATION

1. Contractor’s Name and Address:

2. Point of Contact:

3. Phone Number:

4. Contract Number: Contract Type:

5. Project Title:

6. Period of Performance:

SECTION B: RESPONDENT INFORMATION (To Be Completed By Evaluation Respondent)

1. Respondent’s Company Name & Address:

2. Respondent’s Name:

3. Phone Number: Fax Number:

E-Mail:

4. Contract Number: Contract Type:

5. Award Amount: Final Amount:

6. Project Title:

7. Period of Performance:

C. FAX or Email COMPLETED QUESTIONNAIRE FORM TO: 1st Special Operations Contracting Squadron/LGCB, 350 Tully St, Bldg 90339,Hurlburt Field, FL 32544-5810, Attention: Jordan Roby or Tina Kneip; jordan.roby @hurlburt.af.mil or tina.kneip@hurlburt.af.mil; FAX : (850) 884-1272

THIS FORM MUST BE RETURNED NO LATER THAN: The closing date and time of solicitation.

mailto:jordan.roby%20@hurlburt.af.mil mailto:tina.kneip@hurlburt.af.mil

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

Unsatisfactory Marginal Not Available Satisfactory Above Average Outstanding

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

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

No record of past performance or the record is inconclusive.

Performance met contract 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.

Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner

1. Developed realistic progress schedules and completed the project within 1 2 3 4 5 6 the established schedule.

COMMENTS/REMARKS:________________________________________________________________________

2. Provided experienced superintendent, managers, and supervisors, with 1 2 3 4 5 6 the technical and administrative abilities to meet requirements.

COMMENTS/REMARKS:________________________________________________________________________

3. Adequately coordinate and controlled performance of subcontractors. 1 2 3 4 5 6 COMMENTS/REMARKS:________________________________________________________________________

4. Provided effective quality control which resulted in a quality finished product. 1 2 3 4 5 6 COMMENTS/REMARKS:________________________________________________________________________

5. Provided submittals in a timely manner. Submittals were 1 2 3 4 5 6 well researched and clearly identified the proposed item.

COMMENTS/REMARKS:________________________________________________________________________

6. Identified problems as they occurred. Suggested approaches to resolving problems. 1 2 3 4 5 6 Displayed initiative and cooperation in solving 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 6 COMMENTS/REMARKS:________________________________________________________________________

8. Contractor was compliant with labor standards, posting of EEO, labor rates, minimum wage.

Payrolls were completed properly and received in a timely matter. 1 2 3 4 5 6 COMMENTS/REMARKS:________________________________________________________________________

9. Contractor had an adequate safety plan and it was implemented properly. No safety discrepances were noted 1 2 3 4 5 6 COMMENTS/REMARKS:________________________________________________________________________

10. Was the contractor assessed liquidated damages? YES NO (If Yes, briefly explain the circumstances)

9. Based on the contractor’s overall performance, would you rehire this contractor? YES NO

OVERALL PERFORMANCE RATING 1 2 3 4 5 6

Signature of Rater: ________________________________________________________ Date: ________________