Attachment 6 - Past and Present Performance Questionnaire.doc

"SOURCE SELECTION SENSITIVE IAW FAR 3.104 WHEN FILLED IN"

FA4626-09-R-0036 Attachment 6

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: ____________________ Telephone Number: ____________________

Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

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 and Title of Evaluator: ____________________________

Company Name: ______________________________________ Address: _____________________

Telephone Number: ___________________ _____________________________

Fax Number:

Email Address: _____________________

C. SEND COMPLETED SURVEY FORM TO:

341 CCS/LGCA, 7015 Goddard Drive, Bldg 145, Malmstrom AFB, MT 59402

ATTN; Joon-Woo Choi

FAX: (406) 731-1113

EMAIL: joon.choi@malmstrom.af.mil

DUTY PHONE: (406) 731-4608

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.

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.

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.

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

Remarks:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________