A4_Past_Performance_Questionnaire.pdf

21 Aug 14

PAST PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name:

Address:

Telephone Number:

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:

as the Prime Contractor Sub-Contractor Key Personnel.

* Contractor performed

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 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. EMAILCOMPLETED SURVEY FORM TO: sibyl.reyes@us.af.mil.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (EX, VG, S, M, UNS and NA) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF UNS or NA.

PAST PERFORMANCE ASSESSMENT

RATING DESCRIPTION

Execeptional (EX) The contractor’s performance meets contractual requirements and exceeds many

(requirements) to Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good (VG) 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.

Satisfactory (S) 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.

Marginal (M) 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.

Unsatisfactory (UNS) Performance was not observed or not applicable to the current effort being reported against. Performance does not meet most contractual requirements and recovery is not like in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Not Applicable (NA) Not applicable.

CONTRACTOR’S NAME: CONTRACT NUMBER:

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: EX VG S M U N

N A

1. Provided experienced managers and supervisors 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. Followed approved quality control plan.

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

5. Identified and corrected deficiencies in timely manner and pursuant to their quality control procedures.

6. Provided timely resolution of contract discrepancies.

7. Suggested alternative approaches to problems.

8. Provided service in a timely manner.

9. Was responsive to contract changes.

10. Provided adequate contract supervision.

11. Paid subcontractors/suppliers in a timely manner.

12. Cooperated with Government personnel after award.

13. How has the contractor provided all management, tools, supplies, equipment, and labor necessary to maintain continuous and safe operations of aircraft hangar fire protection systems?

14. Has the contractor successfully performed annual preventative maintenance, inspection/ testing, repair, and certification of fire protection systems located in aircraft hangars, freight terminal and supporting pump houses?

15. Has the contractor abided by Federal and State statutes and National Fire Protection Agencies in regards to safety, security and environmental regulations in the performance of all mechanical and electrical systems concurrent with the annual inspection / testing, repair, and certification cycle?

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

Yes / No

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

Yes / No

CONTRACTOR’S NAME: CONTRACT NUMBER

Remarks:

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire No Later Than 22 Sep 14 to: FAX 609-754-3735 ATTN: MSgt Sibyl Reyes and via email – sibyl.reyes@us.af.mil.