1_J6-PPQuestionnaire 41311.docx

Attachment J-6: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: ___________________________________

B. Contract number: __________________________ CAGE Code: _______________

C. Type Contract/Task Order (underline one) CPFF CPIF CPAF T&M FFP Other: _____

1. Type security clearance required: Secret TS TS/SCI SAP/SAR Other:_____

2. Facility clearance required: Secret SCIF Other_______

D. Total Contract/Task Order Current Value to Date: _____________Status: Active:__ Completed:__

E. Date of Award/Period of Performance: _______________________

F. Contract Completion Date (including extensions): ___________________

G. Was this a competitive contract? Yes ____ No _____

H. Initial contract cost: ________________ Current/Final contract cost: ________________

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

J. Indefinite Delivery/Indefinite Quantity (IDIQ) Contracts only:

1. Please provide the ceiling amount of the master IDIQ contract: $_________________

2. If this is a task order, please provide the ceiling amount: $_________________

3. Period of Performance for the IDIQ contract: _______________________________

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

No ____ Yes___ Default_______ Convenience_______ Pending Terminations________

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

L. Contract Type _______________________________________________________________________

Engineering & Technical Services

Please check the mission area(s) that is/are supported by this Contract/Task Order:

_________ Airlift Support Airlift Operations_________ Information Operations

M. Please provide a detailed description of the work provided by the Contractor. This is extremely helpful to us in assessing the relevancy to our current acquisition. We appreciate your effort and assistance very much: (Feel free to copy and paste or provide the PWS as an Attachment):

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

Customer or agency name: ____________________________________

Geographic location of services under this contract: ____________________________________

SECTION 3: EVALUATOR IDENTIFICATION

Please provide information for primary individual completing this survey.

A. Evaluator’s Name/Title, Telephone Number, Mailing/e-mail Address:

B. Relationship to Contract: ___________________________________

SECTION 4: EVALUATION

A. 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:

VG VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE - Unable to provide a score.

DISCLAMER: If the evaluations provided conflict with CPARS, CPARS will take precedence over individual evaluations.

B. For each question, please place an “X” in the box corresponding to the rating. Please provide supporting rationale for all ratings except “Satisfactory” or “Not Applicable”. The narratives need not be lengthy, just clear and concise. Space for narrative comments is provided at the bottom of the questionnaire. If more space is needed, use the back of the questionnaire or attach additional pages.

CONTRACT/PAST PERFORMANCE INFORMATION QUESTIONNAIRE:

Q1. Accuracy of required deliverables/reports

Q2. Ability of Contractor to meet service specifications of the contract

Q3. Ability of Contractor to provide timely proposals with accurate cost estimates

Q4. Ability of Contractor to respond to short notice requirements

Q5. Ability of Contractor to provide and adhere to Quality Control/Management Plan (when required)

Explanation:

Q6. Ability of Contractor to provide deliverables/reports required by the contract on time

Q7. Ability of Contractor to track and control costs

Q8. Ability of Contractor to provide current, accurate and complete invoices/billing

Q9. Relationship between key Contractor personnel and key Government personnel

Q10. Ability of Contractor to manage, resolve problems and respond to/integrate changes in mission-related requirements

Q11. Ability of Contractor to manage subcontractors to include identification and resolution of subcontractor problems

Q12. Ability of Contractor to attract, recruit, hire, train and retain qualified management and technical personnel to accomplish mission requirements

Q13. Ability of Contractor to ensure continuation of services during personnel absences due to sickness, leave, voluntary or involuntary termination from employment with qualified personnel, within timeframe specified, and with minimal impact to the mission

Q14. Ability of Contractor to maintain currency of any required certifications and/or specialized training

Q15. Understand /complied with customer objectives and technical requirements (i.e., understanding of the work to be accomplished and ability to execute their plan)

Q16. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Q17. For Task Order contracts - effectively manages simultaneous task orders

Q17. Ability of Contractor to obtain appropriate company and personnel security clearances in a timely manner

Q18. Ability of Contractor to safeguard classified materials

Q19. Ability of Contractor to ensure personnel comply with applicable security requirements

Q20. Ability of Contractor to detect, disclose, avoid, and mitigate OCI issues/risks

Q21. Ability of Contractor to provide employee conflict of interest training and compliance with non-disclosure policy

SECTION 5: NARRATIVE SUMMARY

A. Was this contract partially or completely terminated for default or convenience or are there any pending terminations? (Place an “X” by all that apply.)

Yes No Default Convenience Pending Terminations

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

B. Would you have any reservations about having this contractor perform again on one of your critical and demanding programs?

Evaluator’s Signature Date

NARRATIVE SUMMARY FOR ALL CONTRACTS

(DO NOT INCLUDE PERSONAL NAMES IN THE NARRATIVE SECTION.)

N1. What were the contractor’s greatest strengths in the performance of the contract?

N2. What were the contractor’s greatest weaknesses in the performance of the contract?

N3. Would you award another contract to this contractor?

N4. Comments on the above sections for Technical, Program Management, Small Business Participation, Cost Performance:

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

1. Do you know of any other contracts performed by this contractor? If yes, please provide the following contract information, if known:

a. Contract Number: _______________________________________________________

b. Contract Name: ________________________________________________________

c. Type of Contract: ________________________________________________________

d. Status: Active Completed:________

e. Date of Award: __________________________________________________________

f. Contract Amount: ________________________________________________________

g. Contract Completion Date (Including Extensions): ______________________________

Thank you!

Please return this by e-mail to the Government POC, Daniel Fadely Daniel.Fadely@scott.af.mil and Eric Hassenplug at Eric.Hassenplug@scott.af.mil or (fax to 618-256-9966 /DSN 576-9966).

Once complete, this form contains Source Selection Information IAW FAR 3.104