A-15 Attachment 6 Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

The government is placing emphasis in its acquisitions on past performance as an evaluation factor. The information that will be provided in this questionnaire is significantly more important than cost or price in determining a source to award subject solicitation.

Part I needs to be completed by the Offeror then forwarded to his/her Reference in accordance with the instructions below.

Part II needs to be completed by the Reference then forwarded to the 366 Contracting Squadron in accordance with the instructions below.

PART I. OFFEROR'S PAST OR PRESENT CONTRACT INFORMATION

Instructions on how to fill out questionnaire. First make sure the document is protected (locked). Then you can use the "Tab" key to tab through each line or you can use your mouse to click on the line you want to type in your applicable information. Do not type past the length of the line. Tab to the next appropriate line to continue. If more space is needed, then go to page 8 to continue narration. Be sure to identify your continued narration with the appropriate line number. Upon completion click "Save" to save your information.

Instructions on how to forward questionnaire. When you have completed your portion of this questionnaire, you then need to forward this to your Reference. It is preferred that you forward this via electronic means. It is advised that you use return receipt. Be sure to attach a cover letter requesting your Reference fill out the evaluation portion and forward to the 366 Contracting Squadron on or before the Offer/Due Date and Time. The 366 Contracting Squadron should receive this completed questionnaire via electronic means directly from your Reference. Printed hard, typed or hand written copies will still be accepted via mail or Fax.

1. Contractor (Name, Address, and Zip code):

2. Contract Number: __________________________________________________________

3. Program/Project Title: _____________________________________________________

4. Type of Contract: Fixed Price |_| Cost Reimbursement |_| Other|_| (Explain)

5. Description, location, and relevancy of work:

6. Brief description of effort as Prime |_| or Subcontractor |_|.

(Please indicate whether it was development and/or production, or other acquisition phase and highlight portions considered most relevant to current acquisition).

7. Complexity of Work: Difficult |_| Routine |_|

8. Performance Period: _______________________________________________________

9. Date of Award: ___________________________________________________________

10. Original Contract Dollar Value: _____________________________________________

11. Current/Completed Contract Dollar Value: ____________________________________

12. If amounts for 10 and 11 above are different, provide a brief explanation

13. Contract Completion Date (including extensions): ______________________________

14. Type and Extent of Subcontracting: __________________________________________________________________________

15. Point of Contact Information:

a. Procuring Contracting Officer:

Name: ______________________________________________________________ Address: ____________________________________________________________ Telephone Number: ___________________________________________________ E-mail: _____________________________________________________________

b. Administrative Contracting Officer (if applicable):

Name: ______________________________________________________________ Address: ____________________________________________________________ Telephone Number: ___________________________________________________ E-mail: _____________________________________________________________

c. Contracting Officer's Representative:

Name: ______________________________________________________________ Address: ____________________________________________________________ Telephone Number: ___________________________________________________ E-mail: _____________________________________________________________ PART ll. RESPONDENT/GOVERNMENT OFFICIAL'S INFORMATION AND PERFORMANCE EVALUATION

The government is placing emphasis in its acquisitions on past performance as an evaluation factor. You have been provided as a reference in response to the solicitation for Roofing Indefinite Delivery Indefinite Quantity at Mountain Home AFB ID. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to the 366 Contracting Squadron in accordance with the instructions listed below.

The individual knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's performance with the judgment of others within their organization, as applicable.

Instructions on how to fill out questionnaire: First make sure the document is protected (locked). Then you can use the "Tab" key to tab through each line or you can use your mouse to click on the line you want to type in your applicable information. Do not type past the length of the line. Tab to the next appropriate line to continue. For the evaluation portion it is easiest to use the mouse to point and click on the square of your choice. Choose just one square for each item. Upon completion click "Save" to save your information.

Instructions on how to forward questionnaire: When you have completed your portion of this questionnaire, you then need to forward this to the 366 Contracting Squadron, attention Jamie M. Sachette, before the Proposal due Date and Time. It is preferred that you forward this via electronic means. It is advised that you use return receipt. The 366 Contracting Squadron should receive this completed questionnaire via electronic means directly from the Reference. Printed hard, typed or hand written copies will still be accepted via mail or Fax.

Proposal Due Date and Time: 20 May 2010, 3.00 P.M. Local Time

E-Mail to: jamie.sachette@mountainhome.af.mil

FAX to: (208) 828-4031 or DSN 728-4031

Mail to: 366 Contracting Squadron Attn: Jamie M. Sachette 366 Gunfighter Avenue Suite 498 Mountain Home AFB, ID 83648-5258

P.O.C: Jamie M. Sachette at 208-828-1950 or DSN 728-1950

1. Respondent/Government Official's Information

2. Relationship and time involved with Contractor:

3. Date questionnaire was completed: ___________________________________________

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

For any neutral, marginal, or unsatisfactory rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, mark N/A. If more space is needed, use the back of the questionnaire or attach additional pages. Be sure to identify your continued narration with the respective line number.

g. Identification/correction of deficient work in a timely |_| |_| |_| |_| |_| |_| |_| manner.

h. Suggested solutions and initiative to implement |_| |_| |_| |_| |_| |_| |_| solutions.

Remarks:

b. Submittals were well researched and clearly |_| |_| |_| |_| |_| |_| |_| identified the proposed item.

c. Submittals accurately matched contract requirement. |_| |_| |_| |_| |_| |_| |_|

f. Submission of updated and revised progress schedules. |_| |_| |_| |_| |_| |_| |_|

Remarks:

Management Effectiveness

supervisors with the technical and administrative abilities needed to meet contract requirements.

b. Hired experienced subcontractors. |_| |_| |_| |_| |_| |_| |_|

c. Paid subcontractors/suppliers in a timely manner. |_| |_| |_| |_| |_| |_| |_|

d. Provided well-substantiated pricing data for |_| |_| |_| |_| |_| |_| |_| modifications.

e. Completed all contract work prior to requesting final |_| |_| |_| |_| |_| |_| |_| inspection. Left no major discrepancies.

f. Contractor provided timely and satisfactory response |_| |_| |_| |_| |_| |_| |_| to warranty issues after project completion.

g. The contractor cooperated to resolve problems, |_| |_| |_| |_| |_| |_| |_| attended meetings (as applicable), and maintained communication to assure satisfactory resolution.

Remarks: __________________________________________________________________________

7. Pricing E VG S N M U N/A

a. The contractor submits proposals that accurately |_| |_| |_| |_| |_| |_| |_| represent the work required.

b. The contractor's supporting price/cost information for |_| |_| |_| |_| |_| |_| |_| modifications is accurate, complete, and reasonable (not over-inflated or under-estimated).

c. The contractor's overall pricing performance. |_| |_| |_| |_| |_| |_| |_| Remarks:

requirements and safety regulations.

b. Site manager acted promptly to resolve problems |_| |_| |_| |_| |_| |_| |_| and ensure work quality.

c. Site manager had sufficient authority to make |_| |_| |_| |_| |_| |_| |_| decisions or take actions during project performance.

d. Site manager consistently present on site when work |_| |_| |_| |_| |_| |_| |_| was performed.

Remarks: __________________________________________________________________________

c. Compliance with labor laws and regulations with |_| |_| |_| |_| |_| |_| |_| specific attention to the Davis-Bacon Act.

Remarks: __________________________________________________________________________

11. Overall Performance Rating E VG S N M U N/A Please rate the contractor's overall performance under |_| |_| |_| |_| |_| |_| |_| this contract.

Remarks: __________________________________________________________________________ The following area is provided for your continued narration if more space was needed.

Be sure to identify your continued narration by its respective Part and Item number (i.e.

Part 1-5: or Part II - 4a). The computer should automatically add pages if it is required as you type your narration.

FA4897-10-R-0006

Attachment 6