Attachment 3 Past Performance Questionnaire.pdf

FA4418-12-R-0003

Attachment 3

GENERAL INFORMATION:

Contractor’s Name: ____________________

Address: __________________________

Telephone Number: ____________________ Fax Number: __________________

Point of Contact: ____________________

Project Title or Brief Description of work: __________________________________________*

Contract Number Provided by Offeror: ____________________ Dollar Amount: _________*

Number of Buildings Maintained: ________* Total Square Footage Maintained: __________*

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.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ___________________________

Address: _____________________ Telephone Number: ___________________

_____________________ Fax Number: ___________________

_____________________ Email Address: ___________________

C. FAX COMPLETED SURVEY FORM TO: Lisa Brooke Boyd (843) 963-5183

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 Satisfactory Very Good

Exceptional

Neutral (N)

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.

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

No record of past performance or the record is inconclusive.

CONTRACTOR’S NAME : ___________________________________

CONTRACT NUMBER: ______________________________________

The contractor:

1.

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

1 2 3 4 5 6 N

2.

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

1 2 3 4 5 6 N

3.

Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6 N

4.

Home office participated in solving significant local problems.

1 2 3 4 5 6 N

5.

Provided timely resolution of contract discrepancies and/or warranty defects.

1 2 3 4 5 6 N

6. Identified risks/problems as they occurred. 1 2 3 4 5 6 N

7. Suggested alternative approaches to problems. 1 2 3 4 5 6 N

8. Displayed initiative to solve problems. 1 2 3 4 5 6 N

9. Provided adequate project supervision. 1 2 3 4 5 6 N

10.

Cooperated with Government personnel after award and was responsive to contract changes.

1 2 3 4 5 6 N

11. Performed Facilities Maintenance Contracts 1 2 3 4 5 6 N

12.

Performed Preventive Maintenance and Inspections

(Large HVAC systems over 50 tons) 1 2 3 4 5 6 N

13.

Performed Preventive Maintenance and Inspections

(Other than large HVAC systems) 1 2 3 4 5 6 N

14. Performed Diesel Engine Maintenance Services 1 2 3 4 5 6 N

15. Performed Generator Maintenance Services 1 2 3 4 5 6 N

16.

Performed Uninterruptible Power Supply (UPS)

Maintenance Services 1 2 3 4 5 6 N

17. Performed Transfer Switch Maintenance Services 1 2 3 4 5 6 N

18. Performed Large Breakers Maintenance Services 1 2 3 4 5 6 N

19.

Performed Overhead and Rolling Doors Maintenance

Services 1 2 3 4 5 6 N

20. Performed Emergency, Urgent & Routine Service Calls 1 2 3 4 5 6 N

21.

Performed Inspection, Testing, and Certification

Facility Inspections 1 2 3 4 5 6 N

22. Performed Boiler Inspection, Testing, and Certification 1 2 3 4 5 6 N

23.

Performed Interior/Exterior Lighting Systems

Inspection, Testing, and Certification 1 2 3 4 5 6 N

24.

Performed Annual Inspection, Testing, and

Certification of Backflow Preventers 1 2 3 4 5 6 N

25.

Performed Contractor's Computerized Maintenance

Management Systems (CMMS) 1 2 3 4 5 6 N

26.

How would you rate the contractor’s overall performance 1 2 3 4 5 6 N

27.

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

YES NO

28.

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

YES NO

29. Is the contractor rated in CPARS? YES NO

Remarks:_______________________________________________________________________