atch 9 Past Performance Questionnaire.pdf

FA5000-12-R-0001

Attachment 9

Past Performance Questionnaire Cover Sheet\

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION A: Contractor Information (to be completed by the contractor requesting information prior to mailing)

A. Contractor’s name and address: _____________________________________________________________ B. Point of Contact: _______________________________________________________ C. Phone/Fax/Email Address: _______________________________________________ D. Contract Number: ______________________________________________________ E. Project Title/Description of Work: ___________________________________________________________ F. Contract Type: Firm-Fixed Price Indefinite-Delivery/Indefinite-Quantity Cost-Reimbursement G. Project Award Date: _________________________ Scheduled Completion Date ______________

Current/Final Completion Date ____________ H. Project Award Amount: _____________________ Current/Final Project Amount ____________________ I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier J. Authorization is hereby granted to provided the information requested in SECTION B of this Questionnaire

(Name and Title of Authorizing Official) (Date)

(Signature)

SECTION B: To be completed by the Reference/Evaluator: Please complete the information below, complete the Past Performance Questionnaire on Pages 2 & 3, and return by fax to: Mike Lankford, 673 CONS/LGCA, FAX

907-552-7497, NO LATER THAN THE PROPOSAL DUE DATE.

EVALUATED BY:

(Signature) (Date)

_____________________________________ Address: _____________________________ (Typed or Printed Name) _____________________________________ (Title)

(Phone) (Fax) (/Email)

NOTE: The identity of individual(s) providing reference information SHALL NOT be disclosed.

URGENT! PLEASE RESPOND PROMPTLY

Past Performance Questionnaire

E S M U N

EXCEPTIONAL SATISFACTORY MARGINAL UNSATISFACTORY NOT APPLICABLE

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

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

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

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

No past performance record or the record is inconclusive.

EVALUATION AREAS

I. Quality / Technical Performance E S M U N

1. Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project. □ □ □ □ □

2. Contractor developed and submitted realistic progress schedules. □ □ □ □ □

3. Contractor provided well researched and clearly identified submittals that matched contract requirements. □ □ □ □ □

4.

Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items.

5. Contractor thoroughly reviewed correspondence for accuracy, completeness, and compliance with contract requirements. □ □ □ □ □

6. Adequacy/effectiveness of environmental / safety procedures. □ □ □ □ □ II. Timely Performance E S M U N

1. Contractor met established project schedules to complete the project on time. □ □ □ □ □

2. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer □ □ □ □ □

3.

Contractor submitted the progress schedule and interim progress reports as required in a timely manner and the schedule was approved prior to actual construction.

4. Contractor provided submittals on time as required. □ □ □ □ □

5. Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled □ □ □ □ □

6. Contractor provided timely resolution of all punchlist items. □ □ □ □ □ III. Management Effectiveness E S M U N

1.

Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Contractor hired quality subcontractors and effectively managed and coordinated their work. □ □ □ □ □

3. Contractor understood/complied with customer objectives and technical requirements. □ □ □ □ □

4. Contractor hired, maintained, and replaced as necessary, qualified personnel and subcontractors/suppliers. □ □ □ □ □

5.

Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule.

6. Contractor provided timely and satisfactory response to warranty □ □ □ □ □ issues after project completion.

7. Contractor paid employees/subcontractors/suppliers as required. □ □ □ □ □

8. Provided timely/effective contract problem resolution without extensive customer guidance. □ □ □ □ □

9. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer □ □ □ □ □

IV. Compliance with Labor Standards E S M U N

1. Contractor facilitated labor inspections for determination of compliance with wage determinations and labor standards. □ □ □ □ □

2. Labor posters and wage determinations were displayed as required. □ □ □ □ □

3. Subcontractor acceptance of labor standard clauses submitted as required. □ □ □ □ □

4. Statement of Compliance for payroll reports was submitted as required. □ □ □ □ □

V. Compliance with Safety Standards E S M U N

1. Adequacy of Safety Plan □ □ □ □ □

2. Implementation of Safety Plan □ □ □ □ □ VI. Cost Performance

1. Accuracy in forecasting contract costs □ □ □ □ □

2. Ability to meet forecasted costs and perform within contract costs □ □ □ □ □

3. Ability to alert Government of unforeseen costs before they occur □ □ □ □ □ VII. Overall Performance E S M U N

1. Please rate the contractor’s overall performance □ □ □ □ □

Please discuss each and every response for which you indicated E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

1. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

NARRATIVE SUMMARY:

What were the contractor’s most positive aspects in the performance of the contract?

What were the contractor’s most negative aspects in the performance of the contract?

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Thank you for your prompt response and assistance!

Evaluator’s Signature Date

Please return this completed questionnaire to:

673 CONS/LGCA

Attn: Mike Lankford 10480 22nd Street, Suite 254 JBER Elmendorf Richardson AK 99506 907-552-5362 michael.lankford@elmendorf.af.mil mailto:michael.lankford@elmendorf.af.mil�