Attachment_6_-_Past_Performance_Questionnaire.pdf

FAR 13.5 TEST PGROGRAM FOR CERTAIN COMMERCIAL ITEMS

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

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

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor:_________________________________________________________________

B. Contractor Cage Code of contract was awarded to: _________________________________

C. Contract number: ______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _______________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: ____________________________________________________

B. Customer or agency description (if applicable): ____________________________________

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name: ___________________________________________________________

B. Evaluator's title: ____________________________________________________________

C. Evaluator's phone/fax number: _________________________________________________

Number of years evaluator worked on subject contract: _________________________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

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Attachment 6

CODE PERFORMANCE RATING

A ACCEPTABLE – The contractor’s performance meets contractual requirements.

The contractual performance was accomplished with minor problems for which corrective actions taken by the contractor were effective.

U UNACCEPTABLE – The contractor’s performance does not meet contractual requirements. The contractual performance reflects problem(s) for which the contractor corrective actions were ineffective.

N/A NOT APPLICABLE – Unable to provide a score

QUALITY

Q1. Conformance to contract requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).

Q2. Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements.

SCHEDULE

T1. Timeliness/effectiveness of contract problem resolution without extensive customer guidance.

T2. Ability to successfully respond to emergency and/or surge situations

T3. Adherence to the required delivery schedules.

BUSINESS RELATIONS

B1. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

B2. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

2. Please discuss every question you evaluated as U (unacceptable).

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or are there any pending terminations?

Yes___ Default___ Pending Terminations___

No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

A U N/A

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SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

SECTION 6: OVERALL RATING

Considering all of the information provided above, please rate the contractor's performance overall.

Acceptable Unacceptable Unknown

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please submit COMPLETED questionnaire to the following:

Email:

kelsey.brightbill@us.af.mil

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