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 5 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. E-MAIL COMPLETED SURVEY FORM TO: nicole.smith.54@us.af.mil

D. PERFORMANCE INFORMATION: Choose the number on the scale of 0 to 5 that most accurately describes the contractor’s performance or situation.

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:

Remarks:_____________________________________________________________________________________

The contractor:

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

0 1 2 3 4 5

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

0 1 2 3 4 5

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

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

0 1 2 3 4 5

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

0 1 2 3 4 5

6. Provided timely resolution of contract discrepancies. 0 1 2 3 4 5

7. Suggested alternative approached to problems. 0 1 2 3 4 5

8. Was responsive to contract changes. 0 1 2 3 4 5

9. Provided adequate project supervision. 0 1 2 3 4 5

10. Paid subcontractors/suppliers in a timely manner. 0 1 2 3 4 5

11. Cooperated with Government personnel after award. 0 1 2 3 4 5

12. Has the contractor operated, maintained and repaired Wastewater Treatment System, with a capacity 4.6 million gallons per day and averaging 2.4 million gallons per day?

0 1 2 3 4 5

13. Does the contractor have experience monitoring and reporting Lab Analysis Plans? 0 1 2 3 4 5

14. Was the offeror evaluated in eSRS? If so, provide copy of the report. 0 1 2 3 4 5

15. Did the offeror attain applicable goals for small business participation under contracts that required subcontracting plans?

0 1 2 3 4 5

16. How would you rate the contractor's overall performance? 0 1 2 3 4 5

17. Was the offeror 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