JA-06_FA5004-16-R-C003_Past_Performance_Questionnaire.pdf

For Official Use Only When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

JA-06 FA5004-16-R-C003 Past Performance Questionnaire

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Section A: Contract Identification

1. Contractor (Company/Division):

2. Contractor Cage Code:

3. Contract Number:

4. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

5. Cost/price:

i. Original Contract Cost/Price $

ii. Value of Negotiated Contract Changes $

iii. Actual/Projected Cost to Complete $

iv. Baseline Estimate at Completion $

v. Cost Under run/Over run (-) $

6. Period of Performance

i. Original Schedule (assuming all options exercised): Start Date End Date

ii. Current Schedule (assuming all options exercised): Start Date End Date

iii. Reason for difference (if applicable):

7. Description of work performed:

8. Was this a competitively awarded contract? Yes No

9. Contractor’s Role: Prime Contractor Subcontractor Key Personnel

Section B: Customer or Agency Identification

1. Customer or agency name:

2. Customer or agency description (if applicable):

3. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

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Section C: Respondent Identification

1. Respondent’s name:

2. Respondent’s title:

3. Respondent’s phone number / e-mail address:

4. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

5. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

6. Other suggested points of contact:

Section D: Performance Information

In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under each question. Provide supporting information for each response in the space provided.

Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

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

E V S M U N/A

Supporting Information:

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

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

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

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

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6. How well did the contractor manage quality/effectiveness of subcontracted efforts?

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

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

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

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

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

12. How accurately did the contractor forecast contract costs?

Government Contracts Only: Was this contract 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).

Section E: General Comments (Choose one of the following and explain your choice in the remarks)

OVERALL PERFORMANCE RATING

E V S M U N/A

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I

Definitely would Probably would Probably would not Definitely would not award to him today given that I had a choice.

Additional Comments:

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Respondent Signature/Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: 354th Contracting Squadron 2310 Central Avenue, Suite 3 Eielson Air Force Base, AK 99702

E-Mail to: jeremy.hemington@us.af.mil