Attachment_5-Past_Performance_Questionnaire-1.pdf

ATTACHMENT 5 - PAST PERFORMANCE QUESTIONNAIRE

Source Selection Sensitive – See FAR 2.101 & 3.104

For Official Use Only

FA4861-14-R-C001 / Past Performance Questionnaire / Page 1 of 3

.In accordance with FAR 2.101 and 3.104, this document is considered source selection information once filled in.

Offeror: Complete Page 1, and then send the questionnaire to the primary customer point of contact most familiar with the performance effort.

Primary Customer: Complete Pages 2-3

The below-named contractor is being considered for award of a contract for Solicitation No. FA4861-14-R-C001 at

Nellis/Creech AFB NV. A primary consideration in our selection process is the contractor’s history of performance of similar efforts. The scope of work includes, but is not limited to: “Base Telecommunications System Operations and

Maintenance Services”. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space, please attach an additional page(s). If you have any questions, please call the Contract Administrator, SSgt

Derek A. Urban at (702)652-8458. Please email the completed questionnaire to: Email to derek.urban.1@us.af.mil

A. GENERAL INFORMATION

Contractor’s Name:

Contractor’s Address:

Telephone Number: Point of Contact:

B. RESPONDENT INFORMATION

Primary Customer’s Name: Title:

Primary Customer’s Organization & Address:

Evaluator’s Name: Evaluator’s Title:

Evaluator’s Phone Number: Number of years Evaluator worked on the contract:

Telephone Number: Fax: Email:

C. CONTRACT INFORMATION

Contract Number: Contract Title:

Period of Performance:

Dollar Amount of Contract: Value of Modifications:

Services Performed:

Was this a competitive contract: Yes / No mailto:david.maida.1@us.af.mil

For Official Use Only

FA4861-14-R-C001 / Past Performance Questionnaire / Page 2 of 3

D. PERFORMANCE INFORMATION

Choose the category on the below scale that most accurately describes the contractor’s performance or situation. Please provide a narrative explanation for any ratings of unacceptable or not available. This scale is defined as follows:

CODE PERFORMANCE RATING

A ACCEPTABLE - During the entire period, the contractor met the requirements of the contract and consistently performed at an acceptable level. Performance was accomplished with some problems, and the contractor took effective corrective action for those problems that did occur.

UA UNACCEPTABLE – During the entire period, the contractor did not meet the requirements of the contract and performance was at an unacceptable level. There were a number of serious problems that required extensive oversight and involvement, and corrective actions were either ineffective or non-existent.

N/A NOT APPLICABLE

Please use the above ratings to describe the contractor’s performance in the following areas:

1. MANAGEMENT EFFECTIVENESS

a. Contractor provided experienced managers and supervisors with technical and administrative abilities to meet contract requirements.

A UA N/A

b. Contractor maintained appropriate staffing levels (number/ qualifications) A UA N/A

c. Contractor’s overall management effectiveness A UA N/A

d. Contractor effectively oversaw/managed subcontractors A UA N/A

COMMENTS/REMARKS:___________________________________________________________________________

COMMENTS/REMARKS:___________________________________________________________________________

2. CUSTOMER SATISFACTION

a. Contractor maintained a professional working relationship A UA N/A

b. Contractor was reasonable and cooperative in resolving customer complaints A UA N/A

c. Contractor was flexible in responding to customer requirements A UA N/A

d. Overall customer satisfaction A UA N/A

For Official Use Only

FA4861-14-R-C001 / Past Performance Questionnaire / Page 3 of 3

3. QUALITY OF SERVICE AND WORKMANSHIP

a. Contractor maintained acceptable standards of workmanship A UA N/A

b. Contractor provided acceptable-quality materials A UA N/A

c. Contractor’s overall quality of service A UA N/A

COMMENTS/REMARKS:___________________________________________________________________________

4. QUALITY CONTROL

a. Contractor provided an adequate quality control plan A UA N/A

b. Contractor adhered to its quality control plan A UA N/A

c. Contractor’s quality control resulted in little/no work on your part to achieve acceptable service (i.e.-few failed inspections)

A UA N/A

d. Contractor documented its quality control checks/corrective actions A UA N/A

e. Contractor’s overall quality control A UA N/A

COMMENTS/REMARKS:___________________________________________________________________________

5. OVERALL PAST PERFORMANCE RATING:

6. If a Government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure

Notices? __________ If yes, please describe:

7. If given the opportunity, would you award another contract to this contractor? YES / NO

If No, please explain response below.