Atch 4-26Q1038_ Dorm Internet_Past Performance Questionnaire.pdf
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- Attached to
- Dorm Internet Services at Whiteman AFB
- Solicitation number
- FA462526Q1038
About this file
This is a Past Performance Questionnaire used by the United States Air Force to evaluate contractor performance for a Dorm Internet Services contract at Whiteman Air Force Base, Missouri (Solicitation Number FA462526Q1038).
The questionnaire is completed by references or previous customers who have worked with the contractor being evaluated. Respondents are asked to provide general information about the offeror, including company name, address, CAGE/DUNS number, and contact details, along with contract information such as the contract title, period of performance, contract number, and total contract value. The evaluation section uses a five-point rating scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, and Not Applicable) to assess contractor performance across 19 specific evaluation areas. These areas include personnel qualifications and retention, quality control procedures, problem identification and resolution, schedule adherence, warranty defect resolution, subcontractor management, preventive maintenance of telecommunications equipment, work order completion and management, technical solution accuracy, record-keeping, cost proposal accuracy, and overall contract performance. Respondents must provide supporting information for each rating and answer whether the contractor received any Contract Discrepancy Reports, Letters of Concern, or Cure Notices, as well as whether they would award another contract to the contractor. The completed questionnaire is returned to 509 CONS/PKA at Whiteman AFB via email to the provided Air Force contracting officers. A Legend of Terms section defines key terminology used throughout the form.
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Text version
FA462526Q1038
PAST PERFORMANCE OUESTIONAIRE
The below-named Contractor/Offeror is being considered for award of a contract for Dorm Internet Services at Whiteman AFB, MO. A primary consideration in our selection process is the Contractor's history of performance of similar efforts. Please make every effort to be thorough in your answers/comments. Completed questionnaires can be returned via email to the following:
509 CONS/PKA
ATTN: MSgt Victor Camacho and Amanda Fragoso Email: victor.camacho.2@us.af.mil and amanda.fragoso@us.af.mil
A. GENERAL INFORMATION
Offeror's Name:
Address:
Offeror's Cage/DUNS:
Telephone Number:
Point of Contact:
B. RESPONDENT INFORMATION
Name:
Title:
Organization & Address:
Telephone: FAX: _
Email:
mailto:victor.camacho.2@us.af.mil mailto:amanda.fragoso@us.af.mil mailto:cris.hernandez@us.af.mil
C. CONTRACT INFORMATION
Contract Title:
Period of Performance:
Contract Number:
Total contract value, including all modifications and options:
Description of contract effort:
D. PERFORMANCE INFORMATION
The Air Force will use your survey responses to determine a level of confidence, based on the Offeror's past performance record, concerning the Offeror's ability to successfully perform our requirement in accordance with the contract.
RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCEINFORMATION TO
OFFEROR SUBMITTING A PROPOSAL FOR THIS SOLICITATION.
In the table below, indicate your rating for the contractor's performance by placing an "X" in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:
Code Performance Rating
E EXCEPTIONAL - Performance meets contractual requirements and exceeds many requirements to the Government's benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
V VERY GOOD - Performance meets contractual requirements and exceeds some requirements to the Government's benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
S SATISFACTORY - Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
M MARGINAL - Performance does not meet some contractual requirements. The contractual performance 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.
U UNSATISFACTORY -Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
NIA NOT APPLICABLE - Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.
E. PERFORMANCE EVALUATION AREAS
Please use the above ratings and their assigned definitions to describe the Offeror's performance in the following areas:
The Contractor: E V s M
1. Assigned personnel with the required skills to accomplish the work.
SUPPORTING INFORMATION:
2. Demonstrated the ability to, maintain, and replace, if necessary, qualified personnel during the contract period.
3. Home office participated in solving significant local problems.
4. Provided effective quality control and/or inspection procedures to meet contract requirements.
5. Followed approved quality control plan. SUPPORTING INFORMATION:
6. Identified problems as they occurred. SUPPORTING
INFORMATION:
u NIA
The Contractor: E V s M u NIA
7. Displayed initiative to solve problems.
8. Developed realistic progress schedules.
9. Met established project schedules. SUPPORTING
10. Provided timely resolution of warranty defects. SUPPORTING INFORMATION:
11. Hired experienced subcontractors. SUPPORTING
12. Paid subcontractors/suppliers in a timely manner. SUPPORTING INFORMATION:
13. Completed appropriate preventive maintenance of telecommunication equipment.
14. Completed work orders on schedule. SUPPORTING
15. Managed work orders without hindering operation and maintenance efforts. SUPPORTING INFORMATION:
16. Provided accurate and appropriate technical solutions. SUPPORTING INFORMATION:
The Contractor: E V s M u NIA
17. Maintained maintenance and work order records.
18. Provided accurate and complete line item cost proposals including all aspects of work required for each task.
19. How would you rate the contractor's overall performance on this contract?
F. Did the Contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? If yes, please describe:
G. If given the opportunity, would you award another contract to this Contractor?___
Please explain response below:
Signature of Respondent Date_
Job Title:
Thank you for taking the time to complete this questionnaire.
LEGEND OF TERMS
OFFEROR: The Contractor for which past performance is being evaluated
SOLICITATION NUMBER: The procurement document number the Government uses to identify a specific Request for Proposal (RFP)
RESPONDENT: The person and/or organization evaluating past performance
CONTRACT NUMBER: If the Offeror had a contract or purchase order with your company/firm, the identifying contract number associated with awarded contract/purchase order
CONTRACT TITLE: Project title of work performed
CONTRACT VALUE: Contract/purchase order total dollar value, including all modifications and options
BRIEF DESCRIPTION OF WORK: Describe type of work being performed, to include personnel, equipment, tools, supervision, and other items and services.
Thank you for your prompt response and assistance!
| PAST PERFORMANCE OUESTIONAIRE |
| A. GENERAL INFORMATION |
| B. RESPONDENT INFORMATION |
| C. CONTRACT INFORMATION |
| D. PERFORMANCE INFORMATION |
| RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCEINFORMATION TO OFFEROR SUBMITTING A PROPOSAL FOR THIS SOLICITATION. |
| E. PERFORMANCE EVALUATION AREAS |
| The Contractor: E V s M |
LEGEND OF TERMS
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