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Past Performance Questionnaire Cover Sheet
WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104
SECTION A: Contractor Information (to be completed by the offeror prior to mailing to the reference):
A. Contractor’s name and address:
B. Point of Contact: C. Phone/Fax/Email Address:
D. Contract Number:
E. Project Title/Description of Work:
E(1) |_| Design |_| Design-Build |_| Build F. Contract Type: |_| Firm-Fixed Price |_| Indefinite-Delivery/Indefinite-Quantity |_| Cost-Reimbursement |_| Other, specify
| G. Project Award Date: | | Scheduled Completion Date: Current/Final Completion Date: |
| H. Project Award Amount: | Current/Final Project Amount: | |
| I. Contractor being evaluated performed as the: |_| Prime Contractor | |_|Subcontractor |_| Key Personnel |_| Supplier | |
J. Authorization is hereby granted to provide the information requested in SECTION B of this Questionnaire
(Name and Title of Authorizing Official) (Signature) (Date)
SECTION B: To be completed by the Reference/Evaluator: Please complete the information below and the Past Performance Questionnaire and return by fax, email, or mail to contacts listed in Section C.
THIS FORM MUST BE RETURNED NO LATER THAN: The closing date of the solicitation
*EVALUATED BY:
| _______________________________________________ | _______________________________________ | |
| (Signature) | | (Date) |
| _____________________________________ | _______________________________________ | |
| (Typed or Printed Name) | | (Title) |
(Address, City, State and Zip)
(Phone) (Fax) (/Email) *NOTE: The identity of individual(s) providing reference information SHALL NOT/WILL NOT be disclosed.
| Attachment 6 |
| FA4417-14-R-0001 |
| 20 February 2014 |
URGENT! PLEASE RESPOND PROMPTLY
Past Performance Questionnaire
| 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 |
EVALUATION AREAS
| I. Quality / Technical Performance |
| O |
| A |
| S |
| M |
| U |
| N/A |
| Descriptive comments are appreciated! |
| 1. |
| Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project. |
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| 2. |
| Contractor developed and submitted realistic progress schedules. |
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| 3. |
| Contractor provided well researched and clearly identified submittals that matched contract requirements. |
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| 4. |
| Adequacy/effectiveness of environmental / safety procedures. |
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| 5. |
| Proposals were complete and accurate. |
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II. Timely Performance
| 1. |
| Contractor met established project schedules to complete project on time. |
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| 2. |
| Contractor provided submittals on time as required. |
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| 3. |
| Provided timely resolution of deficiencies. |
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| III. Management Effectiveness |
| O |
| A |
| S |
| M |
| U |
| N/A |
| 1. |
| Contractor provided experienced qualified managers and supervisors. |
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| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
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| 3. |
| Contractor understood/complied with customer objectives and technical requirements. |
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| 4. |
| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance. |
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| 5. |
| Contractor paid employees/subcontractors/suppliers as required. |
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| 6. |
| Provided timely/effective contract problem resolution without extensive customer guidance. |
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| 7. |
| Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer |
| IV. Compliance with Labor Standards |
| O |
| A |
| S |
| M |
| U |
| N/A |
| 1. |
| Contractor facilitated labor inspections for determination of compliance with wage determinations and labor standards. |
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| 2. |
| Labor posters and wage determinations were displayed as required. |
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| 3. |
| Subcontractor acceptance of labor standard clauses submitted as required. |
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| 4. |
| Statement of Compliance for payroll reports was submitted as required. |
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| V. Compliance with Safety Standards |
| O |
| A |
| S |
| M |
| U |
| N/A |
| 1. |
| Adequacy and implementation of Safety Plan. |
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| VI. Overall Performance |
| O |
| A |
| S |
| M |
| U |
| N/A |
| 1. |
| Please rate the contractor’s overall performance |
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In order to understand the basis for the rating in the NARRATIVE SUMMARY section, please discuss and describe each response for which you indicated O (Outstanding), M (Marginal) or U (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).
Was the contractor ever issued a cure or show cause notice under the referenced contract? No ___ or Yes___.
If yes, explain outcome in “remarks.”
Government Contracts Only: Was the contractor assessed liquidated damages? No ___ or Yes___.
If Yes, briefly explain the circumstances:
Is this contract evaluation rated in the Contractor Performance Assessment Reporting System? (CPARS) No ___ or Yes___.
NARRATIVE SUMMARY:
Based on the contractor’s overall performance, would you rehire this contractor? No ___ or Yes___.
Please provide any additional comments concerning this contractor’s performance, as desired:
SECTION C. Return COMPLETED Questionnaire Form to:
| | Attn: | 1SOCONS/LGCB |
| | | 350 Tully Street, Bldg 90339, Hurlburt Field AFB, FL 32544 |
| Fax: | | 850-884-1272 or | |
| Email to: | erik.kastmiler.1@us.af.mil and romeo.reyes.1@us.af.mil | | |
Thank you for your prompt response and assistance!