Att3_Past_Performance_Questionnaire_EMCS.pdf

Source Selection Information -- See FAR 2.101 and 3.104 – FOR OFFICIAL USE ONLY

Section 1: Contract Identification A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date __ _ through _

2. Current Schedule (assuming all options exercised):

Beginning Date __ _ through _

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? Yes No

L. Contractor’s Role: Prime Contractor Subcontractor Key Personnel

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2: Customer or Agency Identification A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

Section 4: Performance Information 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.

N/A 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.

The Contractor: E V S M U N/A

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

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

SUPPORTING INFORMATION:

4. Home office participated in solving significant local problems.

SUPPORTING INFORMATION:

5. Followed approved quality control plan.

SUPPORTING INFORMATION:

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

SUPPORTING INFORMATION:

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

The Contractor: E V S M U N/A

SUPPORTING INFORMATION:

8. Provided timely resolution of contract discrepancies.

SUPPORTING INFORMATION:

9. Identified problems as they occurred.

SUPPORTING INFORMATION:

10. Suggested alternative approaches to problems.

SUPPORTING INFORMATION:

11. Displayed initiative to solve problems.

SUPPORTING INFORMATION:

12. Developed realistic schedules IAW the PWS time requirements for each priority level.

SUPPORTING INFORMATION:

13. Met established PWS time requirements for each priority.

SUPPORTING INFORMATION:

14. Provided timely resolution to damaged property in a timely manner and IAW PWS requirements.

SUPPORTING INFORMATION:

15. Was responsive to contract changes.

SUPPORTING INFORMATION:

The Contractor: E V S M U N/A

16. Provided adequate project supervision.

SUPPORTING INFORMATION:

17. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

SUPPORTING INFORMATION:

18. Cooperated with Government personnel after award.

SUPPORTING INFORMATION:

19. How would you rate the contractor's overall performance on this contract?

SUPPORTING INFORMATION:

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

If yes, explain.

EXPLANATION:

Yes

No

21. Would you award another contract to this contractor? If not, explain.

EXPLANATION:

Yes

No

IF THIS WAS A GOVERNMENT CONTRACT:

Did this contract include FAR 52.219-9, Small Business Subcontracting Plan?

Yes No

If yes, did the contractor comply with the clause? Please explain.

Did this contract include FAR 52.219-8, Utilization of Small Business Concerns?

Yes No

If yes, did the contractor comply with the clause? Please explain.

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I definitely would, probably would, might or might not, probably would not or definitely would not award to them today given that I had a choice.

REMARKS:

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

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address:

319th Contracting Flight Attn: Mr. Ja’Haun Stafford 295 Steen Blvd, Bldg. 242 Grand Forks AFB, ND, 58205-6222

FAX to:

(701) 747-4215

E-Mail to:

jahaun.stafford.2@us.af.mil