Atch_3_Past_Perf_Questionnaire.doc

Attachment 3 Past Performance Worksheet/Questionnaire

FA4626-13-R-0008

FA4626-13-R-0008

SOURCE SELECTIVE SENSITIVE IAW FAR 3.104 (When Filled In)

Attachment 3 Past Performance Worksheet/Questionnaire

FA4626-13-R-0008

FA4626-13-R-0008

SOURCE SELECTIVE SENSITIVE IAW FAR 3.104 (When Filled In)

Grounds Maintenance

PAST PERFORMANCE INFORMATION WORKSHEET

Questionnaire

I.

INTRODUCTION:

Please complete this questionnaire. For assistance with this form or to request an electronic copy please notify the contract specialist listed at the address below. Handwritten responses will be accepted. If you need more space than provided, please attach additional pages or write on the back. Please include only relevant information. Responses will be treated as source selection sensitive information. Please submit this information so that it will be received by the Government no later than 2:00pm Mountain Standard Time 4 June 2013. Return the completed questionnaire either by mail, fax or e-mail to the following address:

341st Contracting Squadron Telephone: (406) 731-4018

Attn: Dedra Poitra E-mail:dedra.poitra@us.af.mil

7015 Goddard Drive Fax: (406) 731-3748

Malmstrom AFB, MT 59402-6863

II.

Explanation of codes:

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5 that most accurately describes the contractors’ performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

III.

CUSTOMER/CLIENT IDENTIFICATION:

Please complete the following identifying information and past performance assessment:

Note: If offeror holds or has held multiple contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for each contract.

Contractor’s Name:

Your company/agency name:

Address:

Period of Performance:

(including options)

Description of Services Provided:

Contractor performed as the FORMCHECKBOX Prime Contractor, FORMCHECKBOX Sub-Contractor, FORMCHECKBOX Key Personnel

Type of Contract (check all that apply): [ ]Firm Fixed-Price [ ]Cost Reimbursement [ ]Cost Plus Incentive Fee [ ]Requirements [ ]Indefinite Delivery/Indefinite Quantity [ ]Time & Materials [ ]Award Fee [ ] Other:

IV.

RESPONDENT INFORMATION:

This information pertains to the person completing the questionnaire.

Respondent Name:

Title: (e.g. Contracting Officer, Program Manager, etc.)

Address:

Phone Number:

Fax Number:

E-Mail Address:

V.

QUESTIONS CONCERNING PAST PEFORMANCE:

Place an “X” in the appropriate box next to the number for each item on the questionnaire. Narrative statements are vital. Attach additional pages if there is insufficient space in the comment space.

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

2.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

3.

Home office participated in solving significant local problems.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

4.

Provided timely resolution of contract discrepancies.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

5.

Identified risks/problems as they occurred.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

6.

Displayed initiative to solve problems.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

7.

Cooperated with Government personnel after award.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

8.

Was responsive to contract changes.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

9.

Contractor demonstrated safe work practices IAW OSHA.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

10.

Contractor provided sufficient quantities of equipment to accomplish the requirements.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

11.

Contractor provided appropriate types of equipment to accomplish the requirements.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

12. Contractor was knowledgeable of grounds maintenance techniques suitable to the region and terrain.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

13.

Contractor was knowledgeable of automated irrigation systems and maintenance.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

14. Contractor maintained Improved Areas IAW the Performance of Work Statement (PWS).

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

15. Contractor maintained Semi-Improved Areas IAW the PWS.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

16. Contractor maintained Unimproved Areas IAW the PWS.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

17. Followed accepted Quality Control Plan.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

18. Provided effective quality control and/or inspection procedures to meet contract requirements.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

19. Corrected deficiencies in timely manner and pursuant to their control procedures.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

20. Contractor demonstrated flexibility and capability to effectively manage unscheduled or special mowing requirements (e.g. Special Events).

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

21. Contractor prepared for and executed a level of effort to effectively respond to seasonal changes.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

22. Contractor has experience in maintaining landscape beds.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

23. Contractor has experience in mowing grass on elevated contoured slopes.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

24. Contractor has experience in application of herbicide and fertilizer.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

25. Contractor has experience in planting and removing trees.

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

26. How would you rate the contractor’s overall performance?

FORMCHECKBOX

1 FORMCHECKBOX

2 FORMCHECKBOX

3 FORMCHECKBOX

4 FORMCHECKBOX

27. Was the contractor ever issued a cure or show cause notice under the referenced contract?

YES

FORMCHECKBOX

NO

FORMCHECKBOX

If yes, please explain outcome. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

28. Would you award another contract to this contractor?

YES

FORMCHECKBOX

If no, please explain outcome. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 29.

Is the contractor rated in CPARS?

YES

FORMCHECKBOX