Attch 5 - Past Performance Questionnaire.doc

DOC document 115 KB Posted Aug 30, 2012

Attached to: Paving IDIQ FA4686-12-R-0006 Federal contract opportunity
Solicitation number: FA4686-12-R-0006
Issued by: Department of the Air Force Air Combat Command

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Past Performance Questionnaire

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Other files for this federal contract opportunity

Other files attached to Paving IDIQ FA4686-12-R-0006, newest first.
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Paving IDIQ RFIs Answers.doc	DOC document	Sep 11, 2012
Attch 1 - Basic Statement of Work Revised.doc	DOC document	Sep 11, 2012
Amendment 3 to Specs.pdf	PDF	Sep 11, 2012
Spec Ammendment.pdf	PDF	Sep 7, 2012
Paving IDIQ Pre-Bid Conference Meeting Attendance.pdf	PDF	Sep 7, 2012
Request for Entry_AG	—	Sep 4, 2012
FA4686-12-R-0006 Paving IDIQ Solicitation.doc	DOC document	Aug 30, 2012
Attch 6 - AF 3052 Construction Cost Estimate Breakdown.xls	XLS spreadsheet	Aug 30, 2012
Attch 1 - Basic Statement of Work.doc	DOC document	Aug 30, 2012
Attch 4 - Wage Determinations.doc	DOC document	Aug 30, 2012
AF813.pdf	PDF	Aug 30, 2012
Attch 2 - Seed Project SOW.doc	DOC document	Aug 30, 2012
Attch 3 - Bid Schedule	—	Aug 30, 2012

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Solicitation #: FA4686-12-R-0006

PAST PERFORMANCE QUESTIONNAIRE

The government is placing emphasis in its acquisitions on past performance as an evaluation factor.

Part I needs to be completed by the Offeror then forwarded to his/her Reference in accordance with the instructions below.

Part II needs to be completed by the Reference then forwarded to the 9th Contracting Squadron in accordance with the instructions below.

PART I. OFFEROR'S PAST OR PRESENT CONTRACT INFORMATION

Instructions on how to fill out questionnaire. First make sure the document is protected (locked). Then you can use the "Tab" key to tab through each line or you can use your mouse to click on the line you want to type in your applicable information. Do not type past the length of the line. Tab to the next appropriate line to continue. If more space is needed, then go to page 8 to continue narration. Be sure to identify your continued narration with the appropriate line number. Upon completion click "Save" to save your information.

Instructions on how to forward questionnaire. When you have completed your portion of this questionnaire, you then need to forward this to your Reference. It is preferred that you forward this via electronic means. It is advised that you use return receipt. Be sure to attach a cover letter requesting your Reference fill out the evaluation portion and forward to the 9th Contracting Squadron on or before the Offer/Due Date and Time. The 9th Contracting Squadron should receive this completed questionnaire via electronic means directly from your Reference. Printed hard, typed or hand written copies will still be accepted via mail or Fax.

1. Contractor (Name, Address, and Zip code):

2. Contract Number: __________________________________________________________

3. Program/Project Title: _____________________________________________________

4. Type of Contract: Fixed Price FORMCHECKBOX

Cost Reimbursement FORMCHECKBOX

Other FORMCHECKBOX (Explain)

5. Description, location, and relevancy of work:

6. Brief description of effort as Prime FORMCHECKBOX or Subcontractor FORMCHECKBOX

(Please indicate whether it was development and/or production, or other acquisition phase and highlight portions considered most relevant to current acquisition).

7. Complexity of Work: Difficult FORMCHECKBOX

Routine FORMCHECKBOX

8. Performance Period: _______________________________________________________

9. Date of Award: ___________________________________________________________

10. Original Contract Dollar Value: _____________________________________________

11. Current/Completed Contract Dollar Value: ____________________________________

12. If amounts for 10 and 11 above are different, provide a brief explanation

13. Contract Completion Date (including extensions): ______________________________

14. Type and Extent of Subcontracting: __________________________________________________________________________

15. Point of Contact Information:

a. Procuring Contracting Officer:

Name: ______________________________________________________________

Address: ____________________________________________________________

Telephone Number: ___________________________________________________

E-mail: _____________________________________________________________

b. Administrative Contracting Officer (if applicable):

Name: ______________________________________________________________

Address: ____________________________________________________________

Telephone Number: ___________________________________________________

E-mail: _____________________________________________________________

c. Contracting Officer's Representative:

Name: ______________________________________________________________

Address: ____________________________________________________________

Telephone Number: ___________________________________________________

E-mail: _____________________________________________________________

PART ll. RESPONDENT/GOVERNMENT OFFICIAL'S INFORMATION AND PERFORMANCE EVALUATION

The government is placing emphasis in its acquisitions on past performance as an evaluation factor. You have been provided as a reference in response to the solicitation for Paving Indefinite Delivery Indefinite Quantity at Beale AFB, CA. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to the 9th Contracting Squadron in accordance with the instructions listed below.

The individual knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's performance with the judgment of others within their organization, as applicable.

Instructions on how to fill out questionnaire: First make sure the document is protected (locked). Then you can use the "Tab" key to tab through each line or you can use your mouse to click on the line you want to type in your applicable information. Do not type past the length of the line. Tab to the next appropriate line to continue. For the evaluation portion it is easiest to use the mouse to point and click on the square of your choice. Choose just one square for each item. Upon completion click "Save" to save your information.

Instructions on how to forward questionnaire: When you have completed your portion of this questionnaire, you then need to forward this to the 9th Contracting Squadron, attention SSgt Chrissina Tavake and/or SSgt Aaron Bradby, before the Proposal due Date and Time. It is preferred that you forward this via electronic means. It is advised that you use return receipt. The 9th Contracting Squadron should receive this completed questionnaire via electronic means directly from the Reference. Printed hard, typed or hand written copies will still be accepted via mail or Fax.

Proposal Due Date and Time: TBD E-Mail to: chrissina.tavake@beale.af.mil aaron.bradby@beale.af.mil FAX to: (530) 634-3311

Mail to: 9th Contracting Squadron

Attn: SSgt Chrissina Tavake/SSgt Aaron Bradby 6500 B Street, Bldg 2529 Beale AFB, CA 95903 P.O.C: SSgt Chrissina Tavake at 530-634-3372 or DSN 368-3372

SSgt Aaron Bradby at 530-634-2824 or DSN 368-2824

1. Respondent/Government Official's Information

Name:

Position/Title:

Address:

Telephone Number:

________________________ Fax: _____________________

E-mail:

2. Relationship and time involved with Contractor:

3. Date questionnaire was completed: ___________________________________________

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

Exceptional

Very Good

Satisfactory

Neutral

Marginal

Unsatisfactory

Performance met all contract requirements and exceeded many. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

Performance met all contract requirements and exceeded some. There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

No record of past performance or the record is inconclusive

Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

For any neutral, marginal, or unsatisfactory rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, mark N/A. If more space is needed, use the back of the questionnaire or attach additional pages. Be sure to identify your continued narration with the respective line number.

4. Quality of Work

E VG S N M U N/A

a. Quality of Workmanship

FORMCHECKBOX

b. Adequacy of the Quality Control

FORMCHECKBOX

c. Adequacy of Materials

FORMCHECKBOX

d. Adequacy of Submittals

FORMCHECKBOX

e. Adequacy of As-Builts

FORMCHECKBOX

f. Use of specified materials

FORMCHECKBOX

g. Identification/correction of deficient work in a timely FORMCHECKBOX

FORMCHECKBOX

manner.

h. Suggested solutions and initiative to implement FORMCHECKBOX

FORMCHECKBOX

solutions.

Remarks:

5. Timely Performance

a. Provided submittals in a timely manner.

FORMCHECKBOX

b. Submittals were well researched and clearly FORMCHECKBOX

FORMCHECKBOX

identified the proposed item.

c. Submittals accurately matched contract requirement. FORMCHECKBOX

FORMCHECKBOX

d. Developed realistic progress schedules.

FORMCHECKBOX

e. Met established progress schedules.

FORMCHECKBOX

f. Submission of updated and revised progress schedules. FORMCHECKBOX

FORMCHECKBOX

g. Resolution of delays.

FORMCHECKBOX

h. Completion of punch list items.

FORMCHECKBOX

Remarks:

Management Effectiveness

6. General Business Practices:

a. Contractor provided experienced managers, and

FORMCHECKBOX

supervisors with the technical and administrative abilities needed to meet contract requirements.

b. Hired experienced subcontractors.

FORMCHECKBOX

c. Paid subcontractors/suppliers in a timely manner. FORMCHECKBOX

FORMCHECKBOX

d. Provided well-substantiated pricing data for

FORMCHECKBOX

modifications.

e. Completed all contract work prior to requesting final FORMCHECKBOX

FORMCHECKBOX

inspection. Left no major discrepancies.

f. Contractor provided timely and satisfactory response FORMCHECKBOX

FORMCHECKBOX

to warranty issues after project completion.

g. The contractor cooperated to resolve problems, FORMCHECKBOX

FORMCHECKBOX

attended meetings (as applicable), and maintained communication to assure satisfactory resolution.

Remarks: __________________________________________________________________________

7. Pricing

a. The contractor submits proposals that accurately FORMCHECKBOX

FORMCHECKBOX

represent the work required.

b. The contractor's supporting price/cost information for FORMCHECKBOX

FORMCHECKBOX

modifications is accurate, complete and reasonable

(not over-inflated or under estimated).

c. The contractor's overall pricing performance.

FORMCHECKBOX

Remarks:

8. Site Management/Superintendent

a. Site manager ensured compliance to contract

FORMCHECKBOX

requirements and safety regulations.

b. Site manager acted promptly to resolve problems FORMCHECKBOX

FORMCHECKBOX

and ensure work quality.

c. Site manager had sufficient authority to make

FORMCHECKBOX

decisions or take actions during project performance.

d. Site manager consistently present on site when work FORMCHECKBOX

FORMCHECKBOX

was performed.

Remarks: __________________________________________________________________________

9. Compliance With Labor Standards

a. Submitted payrolls in a timely manner.

FORMCHECKBOX

b. Payrolls were complete and correct.

FORMCHECKBOX

c. Compliance with labor laws and regulations with FORMCHECKBOX

FORMCHECKBOX

specific attention to the Davis-Bacon Act.

Remarks: __________________________________________________________________________

10. Compliance with Safety Standards

a. Adequacy of safety plan.

FORMCHECKBOX

b. Implementation of safety plan.

FORMCHECKBOX

Remarks: __________________________________________________________________________

11. Overall Performance Rating

Please rate the contractor's overall performance under FORMCHECKBOX

FORMCHECKBOX

this contract.

Remarks: __________________________________________________________________________

The following area is provided for your continued narration if more space was needed.

Be sure to identify your continued narration by its respective Part and Item number (i.e.

Part 1-5: or Part II - 4a). The computer should automatically add pages if it is required as you type your narration.

Attachment 5

File details come from the government source that posted it. Updated Nov 14, 2017.