Atch_11_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE COVER LETTER SAMPLE

10 Dec 2012

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a (Describe type of contract.) contract at ____________AFB, ___.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at ___________________

Contracting Officer

1 Atch

Past Performance Questionnaire

Attachment 11 file:///D:/far/Far02.doc%23T2101 file:///D:/far/FAR03.DOC%23b3104

FA4497-13-R-0001

(WHEN FILLED IN)

SOURCE ELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104)

FOR OFFICIAL USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

10 Dec 2012

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor:

Name: _____________________________________________________________________________

Street Address: ______________________________________________________________________

City/State/Zip Code: __________________________________________________________________

Person of Contact (POC): ______________________________________________________________

Email Address: ______________________________________________________________________

Telephone/FAX Numbers: _____________________________________________________________

B. Cage Code of contractor for which contract was awarded to: __________________________________

C. DUNS Number: _____________________________________________________________________

C. Contract Number: ____________________________________________________________________

D. Contract Type: ______________________________________________________________________

E. Was this a competitive contract? Yes ____ No ____

F. Period of performance: From: _________________________ To: ____________________________

G. Initial contract amount: $______________________________________________________________

H. Current/final contract amount: $_________________________________________________________

I. Reasons for difference between initial contract amount and current or final contract amount:

J. Brief description of services provided:

SECTION 2. CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: ____________________________________________________________

B. Customer or agency description (if applicable): ____________________________________________

C. Geographic description of services under this contract; i.e., local, nationwide, worldwide, other

Commands: ___________________________________________________________________________

SECTION 3. EVALUATOR IDENTIFICATION

A. Evaluator’s name: ___________________________________________________________________

B. Evaluator’s title: ____________________________________________________________________

C. Evaluator’s phone/fax number and email address: __________________________________________

D. Number of months/years evaluator worked on subject contract: _______________________________

SECTION 4. EVALUATION

Please indicate your satisfaction with the contractor’s performance by circling the appropriate block using the scale provided below in the response to each question. (PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF EXCEPTIONAL (E), MARGINAL (M) OR

UNSATIFACTORY (U). Use additional sheets, if necessary.

CODE PERFORMANCE RATING

E Exceptional - During the contract period, contractor performance is meeting (or met) all contract requirements consistently exceeding (or exceeded) many. Very few, if any, minor problems encountered. Contractor took immediate and effective correction action.

G Very Good - During the contract period, contractor performance is meeting (or met) all contract requirements and consistently exceeding (or exceeded) some. Some minor problems encountered.

Contractor took timely corrective action.

S Satisfactory - During the contract period, contractor performance is meeting (or met) all contract requirements. For any problems encountered, contractor took effective corrective action.

M Marginal - During the contract period, contractor performance is not meeting (or did not meet) some contract requirements. For problems encountered, corrective action appeared only marginally effective, not effective, or not fully implemented. Customer involvement was required.

U Unsatisfactory - During the contract period, contractor performance is failing (or failed) to meet most contract requirements. Serious problems encountered. Corrective actions were either ineffective or non-existent. Extensive customer oversight and involvement was required.

N Not Applicable - Unable to provide a rating. Contract did not include performance for this aspect.

Do not know.

CONTRACTOR’S NAME : ________________________ CONTRACT NUMBER_______________

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

E G S M U N

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

3. Ability to hire/apply/retain a qualified workforce for the effort(s).

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

5. Home office participated in solving significant local problems.

6. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/ disputes).

E G S M U N

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

8. Followed approved quality control plan.

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

E G S M U N

10. Provided timely/effective contract problem resolution without extensive customer guidance.

11. Identified risks/problems as they occurred.

12. Suggested alternative approaches to issues/problems.

13. Developed realistic progress schedules.

14. Met established project schedules.

15. Response to emergency and/or surge situations

17. Responsive to contract changes.

18. Contractor proposed alternative methods/processes that reduced cost, ensured energy efficiency, improved maintainability or other factors that benefited the customer.

E G S M U N

19. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

20. Provided adequate project supervision.

21. Quality/effectiveness of sub-contracted efforts.

22. Obtained consent of surety for increases in bonding as work-in-progress increased.

23. Paid subcontractors/suppliers in a timely manner.

24. Provided payrolls, submittals and cost estimates in a timely manner.

E G S M U N

25. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

E G S M U N

26. Timely resolution of warranty defects. E G S M U N

27. With respect to the safety plan, the contractor:

a. Followed the safety plan. E G S M U N

b. Had no significant safety issues/problems at the job site(s). E G S M U N

28. The contractor met contractual requirements for the following work elements:

a. Installation of standing seam metal roof. E G S M U N

b. Installation of brick. E G S M U N

c. Installation of brick veneer. E G S M U N

d. Installation of HVAC equipment and ductwork. E G S M U N

e. Installation of Trane Direct Digital Controls. E G S M U N

f. Testing, adjusting, balancing and commissioning of HVAC systems.

E G S M U N

g. Installation of fire suppression systems and associated testing. E G S M U N

h. Installation of fire notification/detection systems and associated testing.

E G S M U N

i. Phased construction. E G S M U N

j. Repair/renovation of offices and latrines. E G S M U N

k. New construction. E G S M U N

29. Co-operated with government personnel after award. YES / NO

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

YES / NO

31. Has the contractor demonstrated a history of environmental compliance? If not, explain in “remarks”.

YES / NO

32. Would you award another contract to this contractor? If not, explain in

“remarks.”

YES / NO

33. How would you rate the contractor’s overall performance? E G S M U N

DESIGN:

A Contractor provided complete, supportable, technically sound designs for the project.

E G S M U N

B Contractor demonstrated the ability to incorporate user’s requirements into the design.

E G S M U N

C Contractor completed designs that were constructed in the same manner as they were designed.

E G S M U N

D Contractor complied with LEED requirements with design submitted.

Section 5. NARRATIVE SUMMARY

A. What were the contractor’s most positive aspects in the performance of the contract?

B. What were the contractor’s most negative aspects in the performance of the contract?

C. Address any annotations of exceptional, marginal, or unsatisfactory performance, referencing the particular element or sub-element. (For example in item 26.f, you may have noted “E” for exceptional.

Provide an explanation of why you feel the contractor performed in an exceptional manner with regard to

“Testing, adjusting, balancing and commissioning of HVAC systems”). Please use additional sheets if necessary.

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

YES ____ Default____ Convenience ____ Pending Termination(s) ____

NO ____

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

CONTRACTOR’S NAME : ________________________ CONTRACT NUMBER__________________

Evaluator’s Signature Date

THANK YOU FOR YOUR PROMT RESPONSE AND ASSISTANCE!

FAX OR E-MAIL COMPLETED QUESTIONNAIRE FORM TO:

Jacqueline J. McGee/Contracting Officer, FAX: 302-677-5207, E-mail: jacqueline.mcgee@us.af.mil

(If you have any questions, please call 302-677-5215.)

mailto:jacqueline.mcgee@us.af.mil