Atch 44- Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

FA4861-19-R-A001

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION – SEE FAR 3.104

NELLIS-CREECH 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 No

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 No _

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

PAST PERFORMANCE

QUESTIONNAIRE FA4861-19-R-

A001

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:

Did Not Meet* Met Exceeded*

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 Did Not Meet* Met Exceeded*

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.

Remarks:

C. Cost Control Did Not Meet* Met Exceeded*

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.

Remarks:

D. Quality Did Not Meet* Met Exceeded*

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

F2. Complied with technical requirements and contract specifications.

Remarks:

Evaluator’s Signature Date

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