J-5_JB-MDL_Past_Performance_Questionnaire.pdf

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 or Brief Description of Work:

Contract Number Provided by Offeror: Dollar Amount:

Contract Period or Dates of Performance Provided by Offeror:

*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.

Contractor performed as the: Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number: Email Address:

C. FAX/SCAN (EMAIL) COMPLETED SURVEY FORM TO: sean.burney.1@us.af.mil and wanda.wilson.1@us.af.mil OR fax to (609)754-4948.

D. PERFORMANCE INFORMATION: Choose the number on the scale of 0 to 5 that most accurately describes the contractor’s performance or situation. Indicate Not Applicable (N/A) as necessary.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS.

PERFORMANCE

RATING

DEFINITION

(5) Exceptional

Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

(4) Very Good

Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

(3) Satisfactory

Performance meets contractual requirements. The contractual performance of the element being assessed contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(2) Marginal

Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s actions appear only marginally effective or were not fully implemented.

(1) Unsatisfactory

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

(0) Not Applicable Unable to provide a score. Performance in this area is not applicable to the effort assessed.

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

The contractor:

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

4. Home office participated in solving significant local problems.

0 1 2 3 4 5 N/A

5. Followed approved quality control plan. 0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

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

0 1 2 3 4 5 N/A

8. Provided timely resolution of contract discrepancies. 0 1 2 3 4 5 N/A

9. Identified problems as they occurred. 0 1 2 3 4 5 N/A

10. Suggested alternative approaches to problems. 0 1 2 3 4 5 N/A

11. Displayed initiative to solve problems. 0 1 2 3 4 5 N/A

12. Was responsive to contract changes. 0 1 2 3 4 5 N/A

The contractor:

13. Provided adequate project supervision. 0 1 2 3 4 5 N/A

14. Paid subcontractors/suppliers in a timely manner. 0 1 2 3 4 5 N/A

15. Cooperated with Government personnel after award. 0 1 2 3 4 5 N/A

16. How would you rate the contractor's overall performance?

0 1 2 3 4 5 N/A

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

“remarks.”

YES/NO

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

YES/NO

19. Is the contractor rated in CPARS? YES/NO/NA

20. Was the Contractor required to provide bonding?

YES/NO/NA

Remarks:_____________________________________________________________________________