Past Performance Questionnaire.docx

FA5004-09-R-C014

Attachment 4

PRESENT / PAST PERFORMANCE

EVALUATION QUESTIONNAIRE

FA5004-09-R-0001

Section A: Contractor Information (to be completed by the contractor prior to mailing or faxing)

a. Contractor’s name and address: ________________________________________

b. Point of Contact: _____________________________________________________

c. Phone #: _____________________________________

d. Contract Number: ________________________ Contract Type: ____________________

e. Project Title: __________________________________________________________________

f. Period of Performance: __________________________________________________________

g. Authorization is hereby granted to provide the information requested in Section B of this Questionnaire.

SECTION B: RESPONDENT INFORMATION (To be completed by Past Performance Evaluation respondents).

a. Respondent’s name and address: __________________________________________

b. Respondent’s Name: ____________________________________________________

c. Phone #: ___________________ E-Mail: ________________________ Fax #: __________________

f. Project Title: _____________________________________________________________

g. Period of Performance: ______________________________________________________

Please mail or FAX the completed questionnaire to:

Performance Evaluation Instructions: When responding to the descriptive statements, select the letter, which most accurately describes the contractor’s performance or situation. If the contractor has no record of past performance relevant to a particular question, select “Neutral”.

Evaluation of the Contractor’s Performance:

I. Quality Control

1. Were you satisfied with the quality of services received? E V S N M U

2. The contractor maintained accurate work order log records, and files; and provided accurate, timely reports? E V S N M U

3. Able to solve contract performance problems without extensive guidance from government counterparts? E V S N M U

4. The contractor provided the necessary equipment and materials to meet the contract requirements? E V S N M U

5. Display responsiveness/timeliness relative to settling of customer complaints?

E V S N M U

6. The contractor provided an effective Quality Control / Inspection procedure, and personnel? E V S N M U

7. The contractor demonstrated the ability to remedy deficiencies in management and overall contract performance? E V S N M U

8. Effective in interfacing with the Government’s staff? E V S N M U

II. Management Effectiveness: To what extent did the contractor…

1. Provide experienced managers, and supervisors with the technical and administrative abilities to meet contract requirements. E V S N M U

2. The contractor demonstrated the ability to hire, maintain and replace in a timely manner, if necessary, qualified personnel during the contract period. E V S N M U

3. Allow site manager sufficient authority to make decisions or take actions during project performance. E V S N M U

4. Contractor responsiveness / timeliness relative to settling of customer complaints. E V S N M U

5. Has the contractor demonstrated unreasonable and uncooperative behavior in resolving customer complaints? YES NO

6. Is the contractor flexible in satisfying the requirements of their customer?

E V S N M U

7. Did this offeror have the necessary experience in “Military Family Housing Maintenance”? YES NO

Explain any negative comments:

III. COST CONTROL:

1. Contractors ability to meet the terms of the contract within the contractually agreed price. E V S N M U

2. Were there any contract concessions/changes/termination’s made due to the contractor failure to accurately estimate costs? YES NO

3. Were there any contract concessions/changes/termination’s made due to the contractors inability to meet technical requirements and / or delivery schedules? YES NO

4. Have there been any indications that the contractor has had any financial problems? YES NO

5. Modifications were priced within reason as compared to the Government estimate? YES NO

6. Did modifications require extensive negotiations? YES NO

IV. TERMINATION HISTORY:

1. Has this contract been partially or completely terminated for default or convenience?

YES DEFAULT CONVENIENCE NO

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

2. Are there any pending terminations? YES NO

If yes, explain and indicate the status. ______________________________________________________________________________________________

3. Have there been any Contract Discrepancy Reports (CDR’s) issued, or are there any pending? YES NO

If yes, explain and indicate the status. __________________________________________________________________________________________

V. OVERALL PERFORMANCE:

1. Rate the contractors overall performance? E V S N M U

2. Would you award to this contractor again? YES NO

3. Briefly describe the contractor’s predominant STRENGTHS and/or WEAKNESSES:

ONCE COMPLETED THIS SURVEY WILL BE CONSIDERED GOVERNMENT OFFICIAL USE ONLY