Past Performance Questionaire Revision 10 April.pdf

FA4659-09-R-0006

20 April 2009

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When filled in this document is Source Selection Sensitive IAW FAR 2.101 and 3.104

SECTION 1: CONTRACT IDENTIFICATION(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: ______________________________

Initial Dollar Amount: $_____________

Final Dollar Amount $_____________

If amounts for “initial” and “final” above are different, provide a brief explanation of the reason:

Date of Contract Award: _______________________

Period of Performance: ________________________

Completion Date:

1. Original Completion Date: ______________

2. Actual/Current Completion: _____________

3. How many times changed: ______________

4. Primary Causes of Change:

*Note: If offeror holds or has held other construction contracts for reparing electric lines with your agency/organization in the last three (3) years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the [ ] Prime Contractor [ ] Sub-contractor [ ] Key Personnel

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

Name of Respondent: ______________________ Title:_________________________

Relation to this Contract: ___________________________________

Address: _______________________ Telephone Number: ____________

Contractor’s Name: _____________________ Contract Number:_______________

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

Number of years evaluator worked on subject contract: _____________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

5 EXCEPTIONAL - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 SATISFACTORY – The contractor’s performance meets contractual requirements.

The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

2 MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

1 UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

Technical Performance 5 4 3 2 1 N

T1 Quality & repeatability of operations & maintenance.

T2 Quality of technical system testing and certification efforts

T3 Quality/integrity of technical data/report preparation efforts

T4 Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

T5 Provided timely resolution of warranty defects

T6 Was responsive to contract changes and obtained consent of surety for increases in bonding as a work-in-progress increased

T7 Adequacy/effectiveness of environmental safety procedures

Program Management 5 4 3 2 1 N

P1. Effectiveness of overall management and supervisors in technical and administrative abilities to meet contract requirements

P2. Contractor was reasonable and cooperative in dealing with your staff

(including the ability to successfully resolve disagreements/disputes)

P3. Timeliness/effectiveness of contract problem resolution without extensive customer guidance

P4. Understand/complied with customer objectives and technical requirements

P5. Successfully responded to emergency and/or surge situations

P6. Quality/effectiveness of sub-contracted efforts

P7. Deveolped realisitic progress schedules

P8. Met established progress schedules

P9. Paid Subcontractors/Suppliers in a timely manner

P10. Was the contractor ever issued or cure or show cause notice for delays in work progress? If yes please explain below.

Program Management 5 4 3 2 1 N

P10. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Employee Retention/Attraction 5 4 3 2 1 N

E1. Ability to hire/apply a qualified workforce to this effort.

E2. Ability to retain a qualified workforce on this effort.

E3. Effectiveness of employee compensation towards quality of work.

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: 319 th

Contracting Squadron

Attn: Shane Lind

575 Tuskegee Airman Blvd Bldg 418

Grand Forks AFB, ND 58204

Or FAX to: (701) 747-5281 Attn; Shane T Lind