JB_Refuse_Past_Perf_Questionnaire.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: __________________ Telephone Number: ____________ Address: ______________ Fax Number: ____________ ___________________________ Point of Contact:_______________

Project Title and Brief Description of Work: *____________________________________

Contract Number Provided by Offeror: ___________________Dollar Amount:___________

Contract Period or Dates of Performance Provided by Offeror: ________________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* 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.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: _____________________ _____________________________ Email Address: _____________________

C. FAX COMPLETED SURVEY FORM TO: SSgt William Washington, 628th CONS, Charleston AFB, SC. Commercial (843) 963-3569 or DSN 673-5183.

OR SEND ELECTRONICALLY TO: william.washington.1@us.af.mil

** Please return by Wednesday 8th August, 2017**

D. 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 EXCEPTIONAL,

MARGINAL or UNSATISFACTORY IN THE REMARKS SECTION BELOW.

E G S M U N Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the Government’s 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 contractual requirements with some exceeded to the Government’s 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 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 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.

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.

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, supervisors, and technicians with the technical and administrative abilities needed to meet contract requirements?

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

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

4. Followed and satisfied Performance Work Statement (PWS) and/or quality control plan?

5. Provided effective quality control and, or inspection procedures to meet contract requirements?

6. Corrected deficiencies and, or satisfied service requirements in a

The contractor: E G S M U N timely manner pursuant to PWS and, or quality control plan?

7. Cooperation and innovation in problem solving?

8. Met established project schedules.

9. Contractor provided and maintained equipment and adequate supplies for employees to effectively perform their job.

10. Promoted good working relationships with technical and contracting office personnel?

11. Identified problems upon occurrence and suggested alternative approaches to solve those problems?

12. Was responsive to contract changes?

13. Responded consistently “on-time” to unscheduled pickups?

14. Provided required and accurate records for review after each month of refuse service?

15. Submitted invoices/billing in a timely manner with minimum delay?

16. Contractor’s responsiveness to customer concerns/complaints?

17. How would you rate the contractor's overall performance?

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

YES/NO

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

YES/NO

20. Is the contractor rated in CPARS? YES/NO

Remarks:______________________________________________________________________