Atch_52_Past_Performance_Questionnaire.doc

FOR OFFICIAL USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

FA4861-16-R-A100

SOURCE SELECTION INFORMATION – SEE FAR 3.104

NELLIS MULTIPLE AWARD CONSTRUCTION CONTRACT (MACC)

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor:

B. Cage Code under which contract was performed:

C. Contract number / Program Title:

D. Contract type (ex: FFP, Cost, T&M):

E. Was this a competitive contract? Yes

No

F. Was it a design-build contract? Yes

G. Period of Performance:

H. Performs duties as: prime contractor _________ sub-contractor________

I. Initial (at time of award) contract value:

(Basic plus all options)

J. Current/final contract value:

(Basic plus exercised options)

K. Reasons for differences between initial contract value and final contract value:

L. Description of work provided:

M. Are there Contractor Performance Assessment Reporting System (CPARS) Evaluation or other Past Performance Reports available for this contract? Yes

N. To help determine program relevancy, please indicate below the work the contractor has or is performing under this contract by placing an “X” in the appropriate block:

A-E Design work

Civil (pavements, site utilities) and/or Structural work

Electrical and/or Communications work

Mechanical (plumbing, HVAC) work

Fire Protection work

Security (secure rooms for classified work) and/or Force Protection work

New Construction (including building additions)

Interior renovation

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or Agency Name: ____________________________________________________ B. Customer or Agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator’s name:

B. Evaluator’s title:

C. Evaluator’s phone/fax number:

D. Evaluator’s email address: ___________________________________________ E. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by marking the performance scale indicated in the appropriate block. The scale is defined as follows:

* Please provide comments for each response you indicated as “Did Not Meet” or “Exceeded” in response to the questions below.

A. Management:

A1. Communicated with Government team and with on-site supervisors to ensure accurate/timely information flow.

A2. Required minimal Government direction regarding contract and technical requirements already available to them (i.e. they read/understand the contract in its entirety).

Remarks:

B. Schedule

B1. Adhered to contract performance schedule, to include timely submission of submittals, close-outs, etc.

B2. Contractor was responsive to warranty calls and quickly fixed legitimate problems.

C. Cost Control

E4. Met and performed within originally awarded contract costs.

E5. Alerted Government of potential unforseen costs/changes before they occur, and submitted cost proposals timely.

D. Quality

F1. Complied with quality control plan and followed contract quality assurance requirements.

F2. Complied with technical requirements and contract specifications.

F3. Ensured poor performance by subcontractors or in-house personnel is not repeated.

Evaluator’s Signature Date

ATTACHMENT 52