Past Performance Questionnaire.doc

DOC document 108 KB Posted Jun 15, 2009

Attached to: HVAC Water Treatment Services Federal contract opportunity
Solicitation number: FA4897-09-R-0004Boals
Issued by: Department of the Air Force Air Combat Command

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File	Type	Posted
Amendment to Solicitation.doc	DOC document	Jun 18, 2009
Wage Determination	—	Jun 15, 2009
Performance Work Statement.doc	DOC document	Jun 15, 2009

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FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

SEE FAR 2.101 and 3.104

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached survey form. This firm is currently being considered for a Heating, Ventilation, and Air Conditioning Water Treatment Services contract at Mountain Home AFB, ID.

Your prompt attention to this survey will be greatly appreciated. If you have any questions concerning this request, I can be contacted at 208-828-3103.

//SIGNED//

TERRY J. OAKLAND

Contracting Officer

GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

___________________ Address:__________________________ Telephone Number:

Fax Number:

Point of Contact:

Project Title or Brief Description of Work: __________________________________________________________________ Contract Number Provided by Offeror: ____________________

Dollar Amount _________________* Contract Period or Dates of Performance Provided by Offeror: __________________________________________________* *Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent:

_____________________ Title:

Address: _____________________ Telephone Number:

Fax Number:

Email Address:

C. Instructions on how to forward questionnaire. When you have completed your portion of this questionnaire you then need to forward to the 366th Contracting Squadron, attention A1C matthew Boals, before the Offer Due Date and Time. It is preferred that you forward this via electronic means to matthew.boals@mountainhome.af.mil . It is advised that you use return receipt. The 366th Contracting Squadron should receive this completed questionnaire via electronic means directly from the Reference. Printed hard, typed or hand written copies will be accepted via mail or Fax. Fax completed survey form to: 366 CONS/LGCA2 Attn: A1C Matthew Boals at 208-828-3105 or mail to 366 Gunfighter Ave, Ste 498, Mountain Home AFB, ID 83648-5296.

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

Unsatisfactory

Marginal

None

Satisfactory

Very Good

Exceptional

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

No record of past performance or the record is inconclusive.

Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner

QUALITY OF SERVICE

a. Ability to meet minimum quality standards specific for performance.

FORMCHECKBOX

b. Compliance with contractual terms and conditions.

FORMCHECKBOX

c. Overall rating of contractor’s quality of service.

FORMCHECKBOX

TIMELINESS OF PERFORMANCE

a. Ability to meet specific response times.

FORMCHECKBOX

b. Timeliness during emergency or off hours calls.

FORMCHECKBOX

c. Provided necessary manpower without sacrificing timeliness or quality.

FORMCHECKBOX

d. Contractor provided timely and satisfactory response to customer complaints.

FORMCHECKBOX

e. Overall rating of contractor’s timeliness of performance.

FORMCHECKBOX

BUSINESS RELATIONS

a. Ability to identify problems and potential problems, and promptly notify the Contracting Officer.

FORMCHECKBOX

b. Ability to correct problems and prevent or mitigate potential problems in a timely manner.

FORMCHECKBOX

c. Willingness to improve and correct noncompliance issues or concerns.

FORMCHECKBOX

d. Extent to which the contractor has demonstrated reasonable and cooperative behavior.

FORMCHECKBOX

e. Working relationship with the Contracting Officer, quality assurance personnel, and customers.

FORMCHECKBOX

f. Flexibility in satisfying the requirements of its customers.

FORMCHECKBOX

g. Overall rating of customer satisfaction

FORMCHECKBOX

h. Overall rating of business relations

FORMCHECKBOX

MANAGEMENT OF KEY PERSONNEL

a. Ability to select and retain cooperative and effective key personnel, such as contract manager.

FORMCHECKBOX

b. Extent key personnel were knowledgeable about contractual requirements.

FORMCHECKBOX

c. Overall rating of contractor’s management of key personnel.

FORMCHECKBOX

COMPLIANCE WITH CONTRACT REQUIREMENTS

a. Contractor demonstrated ability to hire, maintain, and replace, if necessary, personnel with the knowledge, experience, licensure, certification, and abilities needed to meet contract requirements during the contract period.

FORMCHECKBOX

b. Personnel submitted required water quality reports on time.

FORMCHECKBOX

c. Compliance with water quality parameters.

FORMCHECKBOX

CONTRACTUAL CONSIDERATIONS

YES

a. Has an election ever been made not to exercise an option or continue relations because of contractor’s poor performance? If so, explain in “remarks.”

FORMCHECKBOX

b. Has a Contract Discrepancy Report ever been issued?

FORMCHECKBOX

c. Has a cure notice or show cause notice ever been issued?

FORMCHECKBOX

d. The contractor’s supporting price/cost information for modifications was accurate, complete and reasonable (not over inflated or under estimated).

FORMCHECKBOX

e. Overall rating of contractor’s performance under this contract.

FORMCHECKBOX

YES

f. Would you award another contract to this contractor? If not, explain in “remarks.”

FORMCHECKBOX

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ATTACHMENT 3

File details come from the government source that posted it. Updated Nov 14, 2017.