Past Performance Questionnaire MACC.doc

Attachment II

CONTRACTOR PERFORMANCE QUESTIONNAIRE

The below-named contractor is being considered for award of a contract for Solicitation: FA4877-12-R-0008, Multiple Award Construction Solicitation. The scope of work includes efforts involving repair, sustainment, renovation and/or construction of facilities on Davis-Monthan AFB, AZ 85707.

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. Return the completed questionnaire to the following address:

355 CONS/MSCAA

3180 S. Craycroft Road

Davis-Monthan AFB, AZ 85707-3522

Please refer any questions to: SSgt David Maida at (520) 228-4185 or you may email him at the following address: david.maida@dm.af.mil

A. GENERAL INFORMATION

Contractor’s Name:_____________________________________________________________

Address:______________________________________________________________________

Telephone Number: ______________________ Point of Contact: _______________________

B. RESPONDENT INFORMATION

Name: __________________________________ Title: _____________________________

Organization & Address: ________________________________________________________

Telephone: ___________________ Fax: ________________ Email: ____________________

C. CONTRACT INFORMATION

Contract Number/Title: __________________________________________________________

Period of Performance: _________________ Dollar Amount of Contract: _________________

Services Performed: ______________________________________________________________________________

D. PERFORMANCE INFORMATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. 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. HISTORY COMPLETING EFFORTS INVOLVING DESIGN, CARPENTRY, ROAD REPAIR, ROOFING, EXCAVATION, INTERIOR AND EXTERIOR ELECTRICAL, HEATING, VENTILATION, AIR CONDITIONING, PLUMBING, SHEET METAL, PAINTING, DEMOLITION, CONCRETE MASONRY, AND WELDING. (GREATER THAN $1M)

e. Were Contractor change order/equitable adjustment requests reasonable

A UA N/A

COMMENTS/REMARKS:___________________________________________________________________________________________________________________________________________________________________________________________________________________

2. MANAGEMENT EFFECTIVENESS

COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. QUALITY OF SERVICE AND WORKMANSHIP

COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. TIMELINESS/ADHERENCE TO SCHEDULES

COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. QUALITY CONTROL

COMMENTS/REMARKS:___________________________________________________________________________________________________________________________________________________________________________________________________________________

6. CUSTOMER SATISFACTION

COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Compliance with Environmental/Labor/Safety Requirements

COMMENTS/REMARKS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. OVERALL PAST PERFORMANCE RATING: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. If a Government contract, did the contractor receive any Contract Discrepancy Reports, Letters of Concern, or Cure Notices? __________ If yes, please describe:

10. If given the opportunity, would you award another contract to this contractor? Please explain response below.