FA486109RA018_Nellis_Tyndall Water Main_Atch4-Questionairre.pdf

DEPARTMENT OF THE AIR FORCE

99TH CONTRACTING SQUADRON (ACC)

NELLIS AIR FORCE BASE, NEVADA

Enabling America’s Combat Edge

ATTACHMENT #4

PAST PERFORMANCE SURVEY

21-AUGUST-2009

Please return to: TSgt Emily R. Kliolz, Contracting Specialist 99 Contracting Squadron/LGCA 5865 Swaab Blvd, Bldg 588 Nellis AFB NV 89191-7063 702-652-9334; FAX 702-652-2532 or 702-652-4161

Solicitation: FA4861-09-R-A018

REPAIR WATER MAIN, TYNDALL AVE.

NAME OF FIRM TO BE EVALUATED:

The 99th Contracting Squadron is in the process of selecting a contractor for to complete RECOVERY project RKMF 08-0020, Repair Water Main, Tyndall Ave, Nellis Air Force Base, Nevada.

You have been identified as a point of contact for a past and/or present performance evaluation by the firm identified above. Please take a few minutes to complete the following survey. Handwritten responses are sufficient. More than one copy of the questionnaire may be submitted if response on more than one contract is appropriate. Please supplement your answers with information that you feel may be useful in assessing the contractor’s past performance.

Request you provide your written response as soon as possible, but not later than 21-Sep-2009 to allow us sufficient time to analyze the data prior to making a selection for award.

Thank you for your assistance. Your completed questionnaire will greatly help and be one of the keys to the successful and timely completion of this Source Selection.

//SIGNED //

JACQUELYN E. BUKY

Contracting Officer 1 Attachment Questionnaire

PAST PERFORMANCE

EVALUATION QUESTIONNAIRE

Solicitation FA4861-09-R-A018

Source Selection Sensitive

SECTION I: Contract Information (to be completed by the contractor requesting evaluation prior to mailing)

A. Contractor’s name and address:

B. Point of Contact: C. Phone Number (with area code):

D. Email Address:

E. Contract number:

F. Project Title and Brief Description of Work:

G. Contract Type: Firm-Fixed-Price Indefinite-Delivery/Indefinite Quantity Task Order Contract Cost-Reimburseme

H. Project Award Date: Scheduled Completion Date:

Current/Final Completion Date:

I. Project Award Amount: Current/Final Project Amount:

J. Contractor being evaluated performed as the Prime Contractor Subcontractor Key Personnel.

K. Authorization is hereby granted to provide the information requested in SECTIONS 2 & 3 of this Questionnaire.

(Signature of Contractor being evaluated)

(Name and Title of Authorizing Official) (Date)

SECTION II: RESPONDENT INFORMATION (to be completed by respondent.)

EVALUATED BY:

Address:

(Typed or Printed Name)

(Title) Phone Number (with area code): FAX Number (with area coce):

Email Address:

PAST PERFORMANCE, Continued

FA4861-09-R-A018

SECTION III: EVALUATION (to be completed by respondent.)

1. In this section of the questionnaire, you are asked to evaluate the contractor’s performance. If you wish to elaborate on any of your answers, please provide comments at the end of this section. If more space is needed, continue your comments on a separate sheet of paper and attach it to this questionnaire prior to submitting it to the Contracting Office.

2. Any unacceptable or exceptional rating should be supplemented with an explanatory narrative in the remarks block of this survey. If you circle a Yes/No answer that has an asterisk (*), please provide a corresponding explanation in the remarks block.

3. ONCE COMPLETED, THIS SURVEY WILL BE CONSIDERED SOURCE SELECTION SENSITIVE IN

ACCORDANCE WITH FAR PART 3.104. The name of the respondent will not be released.

4. The following definitions are applicable rating levels for the contractor’s performance.

CODE PERFORMANCE LEVEL DESCRIPTION

E

EXCEPTIONAL

(SUBSTANTIAL CONFIDENCE)

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 actions taken by the contractor were highly effective.

S

SATISFACTORY

(SATISFACTORY CONFIDENCE)

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

M

MARGINAL

(LIMITED CONFIDENCE)

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element 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

(NO CONFIDENCE)

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 corrective actions appear or were ineffective.

N

NEUTRAL

(UNKNOWN CONFIDENCE)

Performance was not observed or not applicable to the current effort being reported against.

Choose the appropriate letter on the scale (E, G, S, M, U, or N) that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M OR U.

EVALUATION AREAS for

(NAME OF CONTRACTOR BEING EVALUATED)

The contractor… E S M U N

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

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

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

4. Home office participated in solving significant local problems.

5. Followed approved quality control plan.

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

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

8. Provided timely resolution of contract discrepancies.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Met established project schedules.

13. Provided accurate material submittals as required.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

17. Provided sufficient bonding as required.

18. Obtained consent of surety for increases in bonding when work-in-progress increased.

19. Paid subcontractors/suppliers/employees in a timely manner.

20. Cooperated with Government personnel after award.

21. Provided accurate payrolls within established timelines.

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

23. Is the contractor rated in CCASS? YES NO

24. Has the contractor evere receive a Notice of Violation while construction was being provided? YES NO

25. Was the contractor ever issued a cure or show cause notice under the referenced contract? YES NO 26 Would you award another contract to this contractor? YES NO

COMMENTS ON CONTRACTOR:

(NAME OF CONTRACTOR BEING EVALUATED)

If you answered YES to questions 24-26, or have comments, please provide the additional information below.

EVALUATED BY:

(Evaluator’s Signature) (Date)

NOTE: The identify of individual(s) providing reference information shall not be disclosed.

Thank you for your prompt reponse and assistance.

Please complete and return all pages of this questionnaire to:

Mail to: 99th Contracting Sq/LGCA Attn: TSgt Emily R. Kliolz 5865 Swaab Blvd, Bldg 588 Nellis AFB NV 89191-7063

Or FAX to: 702-652-2532 or 702-652-4161