A2_-_Past_Performance_Questionnaire.pdf

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

27 Apr 2015

FA4484-15-R-0001

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: Transient Alert/Aircraft Wash Services

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: 609-754-4948

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 M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets/met 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/met 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/met 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.

does not meet/did 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.

Performance does not meet/did 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 and supervisors with the technical and administrative abilities needed to meet contract requirements.

The contractor: E G S M U N

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

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

6. Provided timely resolution of contract discrepancies.

7. Identified problems as they occurred.

8. Suggested alternative approaches to problems.

9. Displayed initiative to solve problems.

10. Met established project schedules.

11. Was responsive to contract changes.

12. Provided adequate project supervision.

13. Cooperated with Government personnel after award.

14. How would you rate the contractor's overall performance on this contract?

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

YES/NO

Remarks:______________________________________________________________________