_4_Past_&_Present_Performance_Questionnaire.pdf

FA449719QA025

Attachment 4

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

Address:

Telephone Number:

Fax Number:

Point of Contact:

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: *

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:

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 contractual requirements with many exceeded to the Government’s benefit. The

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual

Performance meets contractual requirements. The contractual performance of the element or sub-element contains

Performance does not meet some contractual requirements.

The contractual performance of

Performance does not meet most contractual requirements and recovery is not likely in a

Performance was not observed or not applicable to the current effort being reported 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 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.

some minor problems for which corrective actions taken by the contractor were satisfactory.

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.

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.

against.

CONTRACTOR’S NAME: _ CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

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.

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.

5. Followed approved quality control plan.

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

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

8. Provided timely resolution of contract discrepancies.

12. Developed realistic progress schedules.

15. Was responsive to contract changes.

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

20. Cooperated with Government personnel after award.

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

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

YES/NO

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

The contractor: E G S M U N

YES/NO

24. Did the contractor show up on time for appointments? YES/NO

25. Has the contractor kept up with renewing licenses? YES/NO

26. Have there been any complaints from costumers? If yes, explain in “remarks.” YES/NO

27. Has there been any other issues with the contractor? If yes, explain in “remarks.” YES/NO

CONTRACTOR’S NAME: _ CONTRACT NUMBER

Remarks: