Attachment_4_-_Past_Performance_Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Reference:FA4417-15-R-0040, Bullet Trap Maintenance

When Filled In This Document Is Source Selection Sensitive Information IAW FAR 2.101 and 3.104

GENERAL INFORMATION:

Contractor’s Name:

Address:

Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work:

Contract Number:

Dollar Amount: $ per *

Contract Period or Dates of Performance Provided by Offeror: *

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

Contractor performed as the:

Prime Contractor Sub-Contractor Key Personnel

A. RESPONDENT INFORMATION:

Name of Respondent:

Title:

Company Name/Address:

Telephone Number:

Fax Number:

Email Address:

B. E-MAIL COMPLETED SURVEY FORM TO:

David Jesmain: david.jesmain.1@us.af.mil -AND- SSgt Xavier Robertson:

xavier.robertson@us.af.mil

C. 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”.

E G S M U N

EXCEPTIONAL

GOOD

SATISFACTORY MARGINAL UNSATISFACTORY

NEUTRAL

Performance meets / met contractual requirements with many exceeded to the respondents’ 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 / met contractual requirements with some exceeded to the respondents’ 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 / met 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 / did 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 / did 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.

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

The contractor: E G S M U N

1.

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2.

Provided adequate project supervision.

3.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

The contractor: E G S M U N

4.

Home office participated in solving significant local problems.

5.

Provided effective quality control and/or inspection procedures to meet contract requirements.

6.

Corrected deficiencies in a timely manner and pursuant to their quality control procedures.

7.

Identified problems as they occurred.

8.

Suggested alternative approaches to problems.

9.

Displayed initiative to solve problems.

10.

Met established project schedules.

11.

Was responsive to contract changes.

12.

Complied with all federal, state and local laws and regulations to include appropriate licensing.

13.

Complied with all DoD regulations (if applicable – leave blank if not a DoD requirement).

14.

Cooperated with Government personnel after award.

15.

How would you rate the contractor's overall performance?

16.

Did this project include work on a military installation?

YES / NO

or NA

17.

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

18.

Would you award another contract to this contractor? If not, explain in “Remarks” section.

19.

Is the contractor rated in CPARS (if applicable for Govt contracts)?

or NA

20. Did the project involve maintenance of a TCT-4 Bullet Trap System? YES / NO or NA

21. Was the project for a plate based Bullet Trap System similar to a TCT- 4 Bullet Trap System? If so please state the type of Bullet Trap System.

or NA

Remarks:

Signature of Respondent Date