Atch_6_-_Past_and_Present_Performance_Survey.pdf

PAST AND PRESENT PERFORMANCE SURVEY

When Filled In This document Is Source Selection Sensitive Information IAW FAR 2.101 and 3.104 Reference: FA4621-13-R-0003

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 3 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: ____________________________

Company Name/Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: _____________________ _____________________________ Email Address: _____________________

C. E-MAIL COMPLETED SURVEY FORM TO: glenda.ali@us.af.mil and matthew.hammond@us.af.mil.

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5 6

OUTSTANDING

ACCEPTABLE

SATISFACTORY

MARGINAL

UNSATIS-

FACTORY

NEUTRAL

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

The contractual 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.

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 or 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.

FA4621-13-R-0003

Past and Present Performance Survey

Attachment 6 mailto:glenda.ali@us.af.mil mailto:matthew.hammond@us.af.mil and 3.104

CONTRACTOR’S NAME: ________________________ CONTRACT NUMBER_______________

Place an “X” in the appropriate column using the definitions matrix above.

The contractor:

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.

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 punchlist items and warranty defects.

FA4621-13-R-0003

Attachment 6 and 3.104

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. 1 2 3 4 5 6

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

1 2 3 4 5 6

22. Did your project include electrical work involving the installation of low voltage distribution? If, yes what was the percentage of the overall requirement was this?

YES/NO

23. Did your project include electrical work involving the installation of medium voltage distribution? If, yes what was the percentage of the overall requirement was this?

25. Did your project include the installation of underground duct banks? If, yes what percentage of the overall requirement was this?

26.

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

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

28. Is the contractor rated in CCAAS or PPIRS? YES/NO

Remarks:________________________________________________________________

FA4621-13-R-0003

Attachment 6