Atch7_Past_Performance_Questionnaire.pdf

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

Attachment 7 to RFP No. FA520517R0006: Past Performance Questionnaire

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The 35th Contracting Squadron of the Air Force at Misawa Air Base is in the process of competitively selecting a source for an acquisition of Airfield/Pavements Indefinite-Delivery Indefinite-Quantity (IDIQ) Contract, Misawa Air Base, Japan.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than _________. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed or mailed to the address specified on page 7 of this questionnaire. Your completed questionnaire will become a part of the official Source Selection records.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

BUNJI YAMAMOTO

Contracting Officer

1 Atch Past Performance Questionnaire http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836

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Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

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

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

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: Respondent Identification

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A. Respondent’s name:

B. Respondent’s title:

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

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

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

F. Other suggested points of contact:

Section 4: Performance Information

In the tables below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of 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.

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.

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Quality Control E VG S M U N/A

Q1. Workmanship and quality control.

Q2. Adequacy / Implementation of CQC plan.

Q3. Adequacy of materials.

Q4. Adequacy of submittals, including as-builts.

Q5. Identification / Correction of deficient work in timely manner.

Effectiveness of Management E VG S M U N/A

E1. Cooperation and responsiveness.

E2. Management of resources / Personnel.

E3. Coordination and control of subcontractors.

E4. Effectiveness of job-site supervision.

Timely Performance E VG S M U N/A

T1. Adequacy of initial progress schedule.

T2. Adherence to approved schedule.

T3. Resolution of Delays.

T4. Submission of required documentation.

Compliance with Labor/Safety Standards E VG S M U N/A

S1. Compliance with labor laws and regulations.

S2. Adequacy of Safety Plan.

S3. Implementation of Safety Plan.

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Cost Performance E VG S M U N/A

C1. How accurately did the contractor forecast contract costs?

C2. How well did the contractor meet forecasted costs and perform within contract costs?

C3. How successfully did the contractor alert the Government of unforeseen costs before they occurred?

Overall E VG S M U N/A

O1. Overall rating of the contractor’s 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).

3. 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 5: NARRATIVE SUMMARY

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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

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Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: 35th Contracting Squadron/Construction Flight Attn: Mr. Satoshi Nogawa Bldg. 656, Misawa Air Base Misawa-shi, Aomori-ken, Japan 033-0012

E-Mail to: satoshi.nogawa.jp@us.af.mil