Attachment 4_Past Performance Questionnaire_Undated_4 pages.pdf

FOR OFFICIAL USE ONLY

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 1

SECTION A: CONTRACTOR INFORMATION

1. Contractor’s Name and Address:

2. Point of Contact:

3. Phone Number:

4. Contract Number: Contract Type:

5. 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. Award Amount: Final Amount:

5. Project Title: Project Number:

7. Period of Performance:

Start Date: End Date:

6. Brief Project Description:

Attachment 4: FA441720R0012, Past Performance Questionnaire, Undated, 4 pages

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 2

SECTION C: EMAIL OR FAX COMPLETED QUESTIONNAIRE FORM TO:

Contract Specialist:

Email:

Contracting Officer:

Email:

OR

Fax: (850) 884-1272

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

SECTION D: PERFORMANCE INFORMATION: Choose letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDEA NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS.

E V S M U N Exceptional

(Outstanding) Very Good

(Above Average) Satisfactory Marginal Unsatisfactory Not Available

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear, or were, satisfactory.

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions.

The Contractor’s proposed actions appear only marginally effective, or were not fully implemented

Performance does 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

No record of past performance or the record is inconclusive.

Attachment 4: FA441720R0012, Past Performance Questionnaire, Undated, 4 pages

1125720699C Typewritten Text Patrick Hall

1125720699C Typewritten Text Marlena N. Perez

1125720699C Typewritten Text marlena.perez@us.af.mil

1125720699C Typewritten Text patrick.hall.4@us.af.mil

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 3

1. QUALITY: Access conformance to contract requirements, specifications and standards of Good Workmanship. Provided effective quality control which resulted in a quality finished product.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

2. SCHEDULE: Developed realistic progress schedules and completed the project within the established schedule.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

3. MANAGEMENT: Provided experienced superintendent, managers, and supervisors, with the technical and administrative abilities to meet requirements. Adequately coordinate and controlled performance of subcontractors.

Identified problems as they occurred. Suggested approaches to resolving problems. Displayed initiative and cooperation in solving problems. Provided adequate information and pricing for change orders and negotiated them in good faith. Provided timely resolution of punch list items and closeout documentation. Provided submittals in a timely manner. Submittals were well researched and clearly identified the proposed item.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 4

4. UTILIZATION OF SMALL BUSINESS: Contractor complied with terms and conditions for Small Business Participation. Achieved Small Business Goals.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

5. REGULATORY COMPLIANCE: Contractor complied with Financial, Environmental, Safety, and Reporting Requirements. Contractor was compliant with labor standards, posting of EEO, labor rates, minimum wage.

Payrolls were completed properly and received in a timely matter. Paid subcontractors in a timely manner Contractor had an adequate safety plan and it was implemented properly. No safety discrepancies were noted.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

6. LIQUIDATED DAMAGES: Was the contractor assessed liquidated damages? ☐YES ☐NO (If Yes, briefly explain the circumstances)

COMMENTS/REMARKS:

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

OVERALL PERFORMANCE RATING:

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

Signature of Respondent: ________________________________________________________ Date: ________________