Attachment 5 - Past Performance Questionaire.pdf

SOURCE SELECTION SENSITIVE IAW FAR 3.104 WHEN FILLED IN

FA4528-20-Q-RO02

Attachment 5

PAST AND PRESENT PERFORMANCE INFORMATION FORM (PPIF)

A. GENERAL INFORMATION:

Contractor’s Name: __________________ Telephone : __________________________ Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

Submitting Survey as Prime or Sub-Contractor (please circle one) If submitting as Sub-Contractor, Prime Contractors Name:___________________________ Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

Project Title and Detailed 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.

B. RESPONDENT INFORMATION:

Name and Title of Evaluator: ____________________________

Company Name: ______________________________________

FA4528-19-R-A018

Attachment 4

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: ______________________ _____________________________ Email Address: ______________________

C. SEND COMPLETED SURVEY FORM TO:

5 CONS/LGCA, 165 Missile Avenue, Minot AFB, ND 58705 ATTN; SrA Robert Robinson FAX: (701) 723-4172 EMAIL: robert.robinson.53@us.af.mil

DUTY PHONE: (701) 723-2262

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 Very Good Satisfactory Marginal Unsatisfactory Neutral

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

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

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

The contractor’s proposed actions appear only marginally effective or were not fully implemented.

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

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

FA4528-19-R-A018

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The contractor: E G S M U N

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

4. Home office participated in solving significant local problems.

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.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules.

13. Met established project schedules.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

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

18. Paid subcontractors/suppliers in a timely manner.

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.”

YES/NO

24. Is the contractor rated in CCASS? YES/NO

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER ______________

Remarks:______________________________________________________________________