JA-3 - Past Performance Questionnaire

PAST/PRESENT PERFORMANCE QUESTIONNAIRE (PPQ)

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: __________________________________________

B. Contractor Cage Code: _________________________________

C. Contract number: ______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: __________________________________________________________

B. Customer or agency description (if applicable): __________________________________________ C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name: __________________________________________________________________

B. Evaluator's title: ___________________________________________________________________

C. Evaluator's phone/fax number: ________________________________________________________

D. Length of time (number of years/months) evaluator worked on subject contract: _________________

SECTION 4: EVALUATION

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:

1. How well did the contractor meet the technical requirements of the specification?

2. How was the quality of technical data preparation efforts?

3. How adequate/effective were the contractor’s environmental safety procedures?

4. How effective was overall contract management (including ability to effectively lead, manage, control and deliver on time)?

5. How reasonable and cooperative was the contractor when dealing with program staff (including the ability to successfully resolve disagreements/disputes)?

6. How timely and effectively did the contractor resolve contract problems without extensive customer guidance?

7. How well did the contractor understand/comply with customer objectives and technical requirements?

8. How successfully did the contractor respond to emergency and/or surge situations?

9. How did the contractor manage quality/effectiveness of sub-contracted efforts?

10. How effective was the contractor’s material management (including Government Furnished Property or Material)?

11. How effective was the contractor’s acquisition management?

12. Of what benefit to the customer were contractor proposed alternative methods that reduced cost, improved maintainability or other factors?

13. To what degree did the contractor implement responsive/flexible processes to improve quality and timeliness of requirements?

14. How smoothly did the contractor transition resources and personnel?

15. How effective was the contractor in maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts?

16. How effectively was the contractor able to hire/apply a qualified workforce to this effort?

17. How effectively was the contractor able to retain a qualified workforce on this effort?

18. How accurately did the contractor forecast contract costs for base contract and any modifications?

19. How well did the contractor meet forecasted costs and perform within contract costs for base contract and any modifications?

20. How successfully did the contractor alert the Government of unforeseen costs before they occurred?

21. How sufficient and timely was the contractor’s cost reporting?

2. Please discuss every response for which you indicated B/E (Blue/Exceptional), Y/M (Yellow/Marginal) or R/U (Red/Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

3. Government Contracts Only: Was this contract partially or completely terminated for default or convenience or are there any pending terminations?

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

SECTION 5: NARRATIVE SUMMARY

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.

Evaluator’s Signature Date

SUBCONTRACTOR CONSENT:

We are currently participating as: CIRCLE ONE ANSWER: member of a joint venture, subcontractor, teaming partner, or key person with the prime contractor identified above in response to the referenced Request for Proposal. We understand that the Government is placing increased emphasis on past performance in order to obtain best value in source selections. In order to facilitate the performance confidence assessment process, we are signing this consent form to allow you to discuss or performance information with the prime contractor during the source selection process.

________________________ (Signature) ________________________ (Name and Title) (Signature and Title of individual who has the authority to sign for and legally bind the company)

Thank you for your prompt response and assistance!

Please return this completed questionnaire to: SSgt Nicholas Bastiani or MSgt Gregory Johnson Mailing Address: 2310 Central Ave Bldg 2258 Eielson AFB, AK 99702 FAX to: 907-377-2547 E-Mail to: nicholas.bastiani@us.af.mil or gregory.johnson.30@us.af.mil

JA-3 Past Performance Questionnaire (11 April 2012)

FA5004-12-R-C003

Base Paving IDIQ