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FOR OFFICIAL USE ONLY FA4664-10-R-0003, Attachment 3
SOURCE SELECTION SENITIVE
IN ACCORDANCE WITH FAR 3.104
When filled in, this document become Source Selection Sensitive in accordance with FAR 3.104
CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE – CONSTRUCTION CONTRACTS
SECTION A: CONTRACTOR INFORMATION: (To be completed by offeror prior to sending to reference provider)
| a. |
| Contractor’s Name/Company: |
Address:
| d. |
| Contract #/Contract Type: |
Authorization is hereby given to provide information in SECTION B of this questionnaire to the government.
| Signature of Contractor Authorized Representative |
| Date |
Printed Name and Title of Authorized Contractor Representative
Instructions to respondents: Thank you for taking the time to fill out this past performance questionnaire. Please fill out the questionnaire and send back within the time frame the contractor has requested (this is TIME SENSITIVE and may adversely affect past performance rating, if not sent back timely). Please answer all questions honestly and accurately.
When completed, please mail, fax, or email to:
| 452 MSG/LGC | | | phone: 951-655-2431, DSN: 447-2431 |
| Evan Porter | | | fax: 951-655-2431, DSN: 447-3772 |
| 1940 Graeber St, BLDG 449 | *email: evan.porter.1@us.af.mil | | |
| March ARB, CA 92518 | | *MS Word (*.doc) or Adobe readable (*.pdf) format only | |
When responding to the following statements choose the response, (yes, no, or N/A) which most accurately represents the contractor’s performance. For each element, (Quality Control, Timely Performance, etc…) rate the contractor by selecting the letter on the scale that most accurately describes the contractor’s overall performance for that element. If the statement is not applicable, then circle “N”. The letters correspond to the following:
(E) Exceptional: 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 action taken by the contractor was highly effective.
(G) Good: 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 which corrective actions taken by the contractor were effective.
(S) Satisfactory: Performance meets contractual requirements. The contractual performance of the elements or sub-elements contains minor problems for which the contractor took satisfactory action.
(M) Marginal: Performance does not meet some contractual requirements. The contractual performance of the elements or sub elements reflects a serious problem for which the contractor has not yet identified corrective actions for or for which the contractor’s proposed actions marginally address the problem.
(U) Unsatisfactory: 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 actions were appeared non-existent or were visibly ineffective.
(N) Neutral: Performance was not observed or not applicable to the current effort being reported against.
SECTION B: PAST PERFORMANCE QUESTIONNAIRE (TO BE COMPLETED BY THE RESPONDENT)
Address:
| d. |
| Contract #/Contract Type: |
Award Amount:
Final Amount:
Date of completion:
Authorization is hereby given to provide information in SECTION B of this questionnaire to the government.
| Signature of Respondent Authorized Representative |
| Date |
Printed Name and Title of Authorized Respondent Representative
RESPONSE SECTION
| 1. |
| Was the quality of the workmanship sufficient? |
| E |
| G |
| S |
| M |
| U |
| N |
| 2. |
| Were the as-built drawings accurate and timely submitted? |
| E |
| G |
| S |
| M |
| U |
| N |
| 3. |
| Was identification/correction of deficient work accomplished timely? |
| E |
| G |
| S |
| M |
| U |
| N |
| 1. |
| Were submittals provided on time? |
| E |
| G |
| S |
| M |
| U |
| N |
| 2. |
| Did the submittals clearly identify the proposed item? |
| E |
| G |
| S |
| M |
| U |
| N |
| 3. |
| Were progress schedules realistic? |
| E |
| G |
| S |
| M |
| U |
| N |
| 4. |
| Were progress schedules met? |
| E |
| G |
| S |
| M |
| U |
| N |
| C. |
| Management Effectiveness |
| 1. |
| General Business Practices |
| a. Were experienced managers/supervisors provided who possessed the technical and administrative abilities necessary to manage the project and meet contractual requirements? |
| E |
| G |
| S |
| M |
| U |
| N |
| b. Were experienced subcontractors hired? |
| E |
| G |
| S |
| M |
| U |
| N |
| c. Were subcontractors/suppliers paid timely? |
| E |
| G |
| S |
| M |
| U |
| N |
| d. Was all contract work completed prior to requesting a final inspection, with no major deficiencies? |
| E |
| G |
| S |
| M |
| U |
| N |
| e. Were timely and satisfactory responses to warranty issues provided after project completion? |
| E |
| G |
| S |
| M |
| U |
| N |
| f. Did the contractor cooperate to resolve problems, attend meetings (as applicable) and maintain effective communication to ensure satisfactory resolution? |
| E |
| G |
| S |
| M |
| U |
| N |
| a. Were price proposals submitted timely accurately representing the required work? |
| E |
| G |
| S |
| M |
| U |
| N |
| b. Was accurate, complete and reasonable supporting pricing information provided for modifications/change orders (not overinflated or underinflated)? |
| E |
| G |
| S |
| M |
| U |
| N |
| 3. |
| Site Management/Superintendence |
| a. Did the site Manager/Superintendent have sufficient authority to make decisions or take action during project performance? |
| E |
| G |
| S |
| M |
| U |
| N |
| b. Was he/she consistently on site while work was being performed? |
| E |
| G |
| S |
| M |
| U |
| N |
| c. Did he/she ensure compliance with contract and safety requirements? |
| E |
| G |
| S |
| M |
| U |
| N |
| d. Was prompt action taken by him/her to resolve problems with work quality? |
| E |
| G |
| S |
| M |
| U |
| N |
| D. |
| Compliance with Labor Standards |
| 1. |
| Were payrolls submitted timely? |
| E |
| G |
| S |
| M |
| U |
| N |
| 2. |
| Were payrolls complete and accurate? |
| E |
| G |
| S |
| M |
| U |
| N |
| 3. |
| Was the contractor compliant with all labors laws and regulations, with specific attention to the requirements of the Davis-Bacon Act? |
| E |
| G |
| S |
| M |
| U |
| N |
| E. |
| Compliance with Safety Regulations |
| 1. |
| Were workplace safety standards and regulations (OSHA, Federal, State, Local and Agency) met? |
| E |
| G |
| S |
| M |
| U |
| N |
| 2. |
| Did the contractor submit and implement/enforce an adequate health and safety plan? |
| E |
| G |
| S |
| M |
| U |
| N |
| F. |
| Compliance with Environmental and Other Standards |
| 1. |
| Did the contractor submit and implement an adequate hazardous waste management plan? |
| E |
| G |
| S |
| M |
| U |
| N |
Please include any additional comments as appropriate:
Do you know of any similar projects the company has completed or is in progress with, if so please provide agency and location?
Location:_____________________________________________________________________________
Please circle the most applicable:
1. I would enter into another contract with this contractor.
2. I might enter into another contract with this contractor.
3. I would not enter into another contract with this contractor.
Evaluator’s Signature:___________________________________________________________________
Evaluator’s Duty Title:___________________________________________________________________ 12-May-10 Page 3 of 5