Atch_22_Past_Performance_Questionnaire_-_25_Aug_15.doc

FA4690-15-R-0005

Attachment 22

PAST PERFORMANCE QUESTIONNAIRE

25 Aug 15 Questionnaire on Contractor’s Present and Past Performance

Request you provide the following information on the contractor’s present and past performance by placing an X in the space provided by the most appropriate response. If you wish to elaborate on your answer, please provide comments on the lines provided after each question. If more space is needed, continue your comments on a separate sheet of paper and attach it to this questionnaire prior to submittal to the 28th Contracting Squadron. You are asked to provide frank, concise comments regarding your overall assessment of the contractor’s performance on the contract identified. You are urged to supplement your own knowledge of the contractor’s performance with the judgment of others in your organization. The following definitions are applicable rating levels of the contractor’s performance on the identified program.

Performance Assessment Rating Description

NO

CONFIDENCE

Based on the offeror’s performance record, your company has no expectation that the offeror will be able to successfully perform the required effort.

Individual’s Name, Title, and Phone Number Completing Questionnaire:

Company’s Name: ______________________________________________________________________

Contractor’s Name:

Contract Number:

Contract Title:

Period of Performance (Including Options): __________________________________________________

Contract Amount (Including Options): ______________________________________________________

Contract Type: Firm Price______ Cost Reimbursement______ Other (Specify)_____________________

MANAGEMENT

1. Rate the contractor on their ability to provide adequate manning and equipment to respond to surge requirements, contingencies, emergencies, and weather delays without falling behind the regular schedule.

Substantial

Satisfactory

Limited

No

Unknown

Confidence

Confidence

Comments: ______________________________________________________________________________________

QUALITY OF SERVICE

2. Rate the contractor on their ability to provide effective quality control and/or inspection procedures to meet contract requirements and their ability to take appropriate action to take to correct deficiencies when identified. (Does the contractor conform to the government accepted quality control plan? Does the contractor provide effective quality control and /or inspection procedures to meet contractual requirements?)

Confidence

3. Rate the contractor’s ability to proactively recognize and resolve unanticipated difficulties. (Does contractor display initiative to solve problems? Does contractor identify risks/problems as they occur?)

Confidence

Comments: _____________________________________________________________________________________

TIMELINESS OF PERFORMANCE

4. Rate the contractor on their ability to provide a sufficient number of qualified personnel to ensure all contract requirements were successfully completed in an expedient manner. (Does contractor demonstrate ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period?)

Confidence

CUSTOMER SATISFACTION

5. Rate the working relationship between the contractor and your company and your designated representatives. (Includes inspection personnel)

Confidence

6. Rate the contractor on their environmental awareness. (Includes environmental compliance and environmental initiatives, such as affirmative procurement)

Confidence

7. Has the contractor ever been given a Cure Notice, Show Cause Notice, Letter of Concerns, or had payment withheld for services not rendered?

Number of Cure Notices: _____

Number of Show Cause Notices: _____

Number of Letter of Concerns: ____

Number of times payment withheld for services not rendered: _____

Comments: ______________________________________________________________________________________

SUMMARY

8. Would you hire this contractor again? Highly Likely Likely Unlikely Highly Unlikely