Attachment_6_-_Performance_Eval_BTS.doc

FA4497-13-R-0002

Source Selection Information - See FAR 2.101 and 3.104

Attachment 6 - PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

RETURN COMPLETED SURVEY FORM NO LATER THAN 4:00 PM ON 19 AUGUST TO:

436 Contracting Squadron Attn: 2d Lt Allison Chermel

Phone Number: 302-677-5226 Fax number: 302-677-2309 or e-mail allison.chermel.1@us.af.mil

A. OFFEROR’S INFORMATION:

Company/Organization Name

Address:

Point of Contact (POC):

Title of POC:

Telephone Number:

Fax Number:

Email

B. RESPONDENT INFORMATION:

Company/Organization Name

Address:

Telephone Number:

Point of Contact (POC):

Title of POC:

Offeror Performed as (Prime Contractor or Sub-Contractor)

C. CONTRACT INFORMATION:

Contract Title:

Contract Number:

Contracting Officer:

Fax/Phone Number

Status (i.e. On-going, complete):

Contract Amount: total amount of base plus any options

Type of Contract

Performance Period: Include base plus any options

Place of Performance:

D. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ E. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5, that most accurately describes the Offeror’s performance or situation. If you are unable to rate an item because it was not a requirement, never an issue, or you have no knowledge of the item in question, then you should mark “NA”.

Confidence

Unknown Confidence

Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. (Risk Level: Very Low)

The Offeror has little/no relevant past performance upon which to base a meaningful performance risk prediction. (Risk Level: Unknown)

The Contractor:

F. OTHER:

(1) Would you award this firm another contract? ( ) Yes, ( ) No. If you answered “No” provide an explanation. _________________________________________________________________________________________________________________________________________________________________________

(2) Was the contract terminated for default? ( ) Yes, ( ) No. If you answered “Yes”, provide an explanation. _________________________________________________________________________________________________________________________________________________________________________

(3) Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, etc.?

( ) Yes, ( ) No. If you answered “Yes”, provide an explanation. _________________________________________________________________________________________________________________________________________________________________________

(4) Based upon the information you provided and using the definitions provided in the evaluation criteria above, the overall performance rating you would give this Contractor is:

Exceptional ___ Satisfactory ____ Marginal ___ Unsatisfactory ____ Unknown ___ COMMENTS: (ALL Unsatisfactory, Marginal, or Exceptional Ratings require comments to support the same. Failure to provide comments will render questionnaire void and will not be accepted by the Government):