Attachment_4_-_Past_Performance_Questionaire.pdf

Attachment 4

FA480919QA003

PAST PERFORMANCE QUESTIONNAIRE

The below-named contractor/offeror is being considered for award of a contract for Packing, Containerization and

Local Drayage of Direct Procurement Method (DPM) Personal Property Shipments at Seymour Johnson AFB, NC.

A primary consideration in our selection process is the contractor’s history of performance of similar efforts. Please make every effort to be thorough in your answers/comments. Completed questionnaires can be returned via email to the following:

EMAIL: nicholas.thomas.17@us.af.mil EAMIL: michael.demers.4@us.af.mil

A. GENERAL INFORMATION

Offeror’s Name:_______________________________________________________________________________

Address:_______________________________________________________________________________

Telephone Number:________________________ Point of Contact:______________________________________

B. RESPONDENT INFORMATION

Name:_____________________________________ Title:_____________________________________________

Organization & Address:_________________________________________________________________________

Telephone: ___________________ FAX:__________________ Email:___________________________________

C. CONTRACT INFORMATION

Contract Title:_________________________________________________________________________________

Period of Performance:__________________________ Contract Number:_________________________________

Total contract value, including all modifications and options:____________________________________________

Annual contract expenditures:_____________________________________________________________________

Description of contract effort:_____________________________________________________________________

(Include whether the effort included the furnishing of personnel, equipment, facilities supplies, services and materials for the preparation of personal property for shipment and/or storage)

D. PERFORMANCE INFORMATION

The Air Force will use your survey responses to determine the level of confidence, based on the offeror’s past performance record, concerning the offeror’s ability to successfully perform our requirement in accordance with the contract. Please assign the following performance level codes to each of the questioned areas listed below based on the contractor’s performance at your organization or installation. The confidence codes selected will indicate the performance in each area.

RESPONDENT WILL NOT FURNISH ANY PAST PERFORMANCE INFORMATION TO OFFEROR SUBMITTING

A PROPOSAL FOR THIS SOLICITATION.

Please indicate your satisfaction with the contractor’s performance by circling the appropriate code using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

S

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 was satisfactory.

US

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/A NOT APPLICABLE - Unable to provide a score.

Please provide detailed narrative comments to support your ratings. At a minimum, please discuss each response for which you indicated US (Unsatisfactory) in response to the questions below (use additional sheets, if necessary) and any performance problems, the contractor’s solutions, and if the solution resolved the problem.

E. PERFORMANCE EVALUATION AREAS

Please use the above ratings and their assigned definitions to describe the offeror’s performance in the following areas:

The contractor: S US NA

1. Met established pick-up/delivery schedules.

2. Provided experienced managers, and supervisors, with the technical and administrative abilities needed to meet contractual requirements. Demonstrated ability to replace personnel if necessary, without project delays

3. Provided effective quality control, which resulted in a quality, finished product.

4. Identified problems as they occurred. Suggested solutions to problems. Displayed initiative to solve problems. Provided adequate information and pricing for modifications.

5. Delivered household goods free of visible dirt, debris, dampness, odor, mildew, cleaning chemical residue, and properly packaged.

6. Made complete deliveries of household goods on delivery dates.

7. Did the contractor have vehicles of the correct type and size to support moves.

8. Did the contractor supply the correct amount of vehicles to support moves.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Cooperated with Government personnel after award.

12. How would you rate the contractor's overall performance?

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

“remarks.”

YES/NO

14. Is the contractor rated in CPARS? YES/NO/NA

COMMENTS/REMARKS_____________________________________________________________________

1. If a government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or

Cure Notices?_____________ If yes, please describe:

2. If given the opportunity, would you award another contract to this contractor?_______

Please explain response below:

3. How would you rate the contractor’s overall performance: S (Satisfactory) US (Unsatisfactory)

Signature of Respondent___________________________________ Date____________

Job Title:________________________________________________________________

Thank you for taking the time to complete this questionnaire.

LEGEND OF TERMS

OFFEROR: The contractor for which past performance is being evaluated

SOLICITATION NUMBER: The procurement document number the government uses to identify a specific Request for Proposal (RFP)

RESPONDENT: The person and/or organization evaluating past performance

CONTRACT NUMBER: If the offeror had a contract or purchase order with your company/firm, the identifying contract number associated with awarded contract/purchase order

CONTRACT TITLE: Project title of work performed

CONTRACT VALUE: Contract/purchase order total dollar value, including all modifications and options

BRIEF DESCRIPTION OF WORK: Describe type of work being performed, to include whether the effort included the furnishing of personnel, equipment, facilities supplies, services and materials for the preparation of personal property for shipment and/or storage.