B-17 - Past Performance Questionnaire - as of 10-09-09.pdf

PPT

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

SUBJECT: Request for Past Performance Evaluation

TO: Whom it May Concern

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Corrosion Control Services contract at Travis AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, contact the Contract Specialist, Bernadette Cruz Breeding, at

(707) 424-7734 or bernadette.breeding@travis.af.mil.

CORA L. ARMSTRONG

Contracting Officer

Atch Past and Present Performance Questionnaire

Atch 4

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: ________________________________________________*

What specific aircraft(s) was included in the performance of the contract and at what wash frequency per year?

*****PLEASE INDICATE THE MONTHLY NUMBER OF CORROSION CONTROL WASHES THE

CONTRACTOR PROVIDED FOR KC-10, C-5, AND C-17, OR EQUIVALENT COMMERCIAL AIRCRAFT.

NUMBER OF MONTHLY WASHES:

1 to 149 ______________________ 150 to 299 ______________________ 300 to 449 ______________________ 450 and above ______________________

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: bernadette.breeding@travis.af.mil

D. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (1, 2, 3, 4, and 5) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF Limited or No Confidence

Number Rating Description

1 SUBSTANTIAL Based on the offeror’s performance record, the government has a high

CONTRACTOR’S NAME: _____________________CONTRACT # ________________________

(Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts.)

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

1 2 3 4 5

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

1 2 3 4 5

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

1 2 3 4 5

4. The contractor provided fully certified qualified individuals. 1 2 3 4 5

5. The contractor kept training current and up to date to maintain qualifications for each employee

1 2 3 4 5

6. The contractor provided adequate supplies & equipment to perform services in accordance with the PWS?

1 2 3 4 5

7. Followed approved quality control plan. 1 2 3 4 5

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

1 2 3 4 5

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

1 2 3 4 5

10. Provided timely resolution of contract discrepancies. 1 2 3 4 5

11. Identified problems as they occurred. 1 2 3 4 5

12. Was responsive to contract changes. 1 2 3 4 5

13. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5

14. Cooperated with Government personnel after award. 1 2 3 4 5 15 How would you rate the contractor's overall performance? 1 2 3 4 5

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

YES NO

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

YES NO

18. Is the contractor rated in CPARS? YES NO

CONFIDENCE expectation that the offeror will successfully perform the required effort.

2 SATISFACTORY

CONFIDENCE

Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

3 LIMITED CONFIDENCE Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort.

4 NO

CONFIDENCE

Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

5 UNKNOWN CONFIDENCE No performance record is identifiable or the offeror’s performance record is so sparse that no confidence assessment rating can be reasonably assigned.

Remarks: