Attach__11_-_Past_Performance_Questionnaire_(PPQ).pdf

Attachment 11

PAST PERFORMANCE QUESTIONNAIRE

MACC - McConnell AFB Kansas

FA4621-16-R-0001

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive Information 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 the Multiple Award Construction

Contract (MACC) at McConnell Air Force Base, Kansas.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, please contact the contract administrator, SSgt Daniel Parks, at (316) 759-3276 or email: daniel.parks.2@us.af.mil. I can be contacted at (316) 759-4513.

Please send the completed attachment to the Contract Administrator. We may also contact you for additional questions and information. Thank you for your assistance.

8/22/2016

X Valerie Brown, GS-12, USAF

Contracting Officer

Signed by: BROWN.LUZ VALERIE.TUBAGA.1401612676

Attachment:

Past and Present Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_629 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5837 mailto:daniel.parks.2@us.af.mil

*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.

PART I. RESPONDENT INFORMATION:

Name of Respondent: _________________________________________________________________

Title: ______________________________________________________________________________

Address: ____________________________________________________________________________

Telephone Number:__________________________

Email Address: ______________________________________________________________________

PART II. CONTRACT / REQUIREMENT / PROJECT INFORMATION:

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

Contractor’s Name: __________________________________________________________________

Address: ____________________________________________________________________________

Telephone Number: ________________________ Fax Number: _______________________________

Point of Contact: _____________________________________________________________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

RECENCY OF REQUIREMENT:

Contract Period or Dates of Performance Provided by Offeror:

Project Start Date: ________________ (Day / Month / Year)

Project End Date: ________________

Contract / Requirement Information:

Contract Number: _________________________

Contract Type: ___________________________ (ID/IQ, FFP, Cost, etc.)

Was this project performed under a MACC, SABER, etc.?

Did this contract have (similar) clauses/terms & conditions such as Liquidated Damages, Material and

Workmanship, Warranty of Construction, etc?

Dollar Amount of project: $______________

Project Title: _______________________________________________________________________

Project Title or Brief Description of Work: _______________________________________________

Brief description or list of construction disciplines used for this requirement (painting, design build, HVAC repair, road work, electrical, plumbing, etc.?)

Was this project performed in the McConnell AFB or Wichita geographical area? State of Kansas?

If NO: Was this project performed in a geographical area away from the contractor’s main business area?

Were sub-contractors used? ______________________

Did this company complete the majority (more than 50%) of the work? _______________________

PART III. PERFORMANCE INFORMATION:

For the below questions, please use the following table for definitions of ratings:

Past Performance Ratings

RATING: DEFINITION:

Exceptional

Performance meets contractual requirements and exceeds many to the

Government's benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good

Performance meets contractual requirements and exceeds some to the Government's benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory

Performance did not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor's corrective actions appear or were ineffective.

UNKNOWN /NA

I do not have sufficient knowledge to provide information.

1. QUALITY OF WORK: RATING: ______________________

What was the overall Quality of work?

Remarks:

2. SCHEDULE: RATING: ______________________

Was the project completed on time?

3. MANAGEMENT: RATING: ______________________

How did the contractor manage the project? Responsiveness to the government/ your company?

Communication? Business relations?

4. REGULATORY COMPLIANCE: RATING: ______________________

How did the contractor comply with contract clauses, terms/conditions, safety/OSHA and other laws/regulations?

Additional Comments: Please feel free to include any other comments regarding this company regarding relevant performance on your requirement: (You may also attach or send copies of CPARS reports, or other relevant documents regarding performance)

Signature of Reviewer Date

(Your) Print Name: ____________________________

Title/Duty Position: ________________________

Phone #: (_____)__________-______________

Email: ____________________________________