Attch 4 - Past Performance Questionnaire.docx

CONTRACTOR PERFORMANCE QUESTIONNAIRE

FA4877-17-R-A001, Repair (Sustain) Central Chiller Plant, Facility 5101

The below-named contractor is being considered for award of a contract for the aforementioned 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 or E-mail:

Please refer any questions to: SSgt Geoffrey Janavaris at 520-228-4967 or Geoffrey.Janavaris@us.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:

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. (Price Range: Greater Than $1 Million)

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 Labor and Safety Requirements.

COMMENTS/REMARKS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

OVERALL PAST PERFORMANCE RATING: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

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