Past_Performance_Questionairre.pdf

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PAST PERFORMANCE QUESTIONNAIRE

Date: 22 May 2017 FROM: 374th Contracting Squadron/LGCA Unit 5228, Bldg 620 Yokota Air Base Fussa-shi, Tokyo 197-0001

1. INSTRUCTION:

374th Contracting Squadron/LGCA, Yokota Air Base, Japan is in the process of selecting a contractor for our U.S. Government contract. The contractor listed below has provided the following contract information as a reference for its (or its subcontractor’s) present/past performance information (PPI).

Please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this contract at paragraph 4, Questionnaire. After completing this survey, please directly send it to this office as instructed on the last page of this survey. In accordance with FAR 15.306(e)(4), the names of individuals providing reference information about an offeror’s present/past performance shall not be disclosed. Your prompt attention to this survey will be greatly appreciated.

2. CONTRACT INFORMATION: (The offeror shall fill in.)

Name of Offeror

PPI Reference No. PPI

If the offeror uses subcontractor’s PPI, provide the subcontractor’s information.

Contracting/Ordering Activity

Contract No. / Title

Period of Performance

Total Contract Value (If multi-year, provide “per year” value too.)

Was a prime contractor or subcontractor?

3. RESPONDENT IDENTIFICATION: (Contracting/Ordering Activity must fill in)

Company Name

Name of Respondent

Job Title for the Contract (Ex. Inspector, Contracting Officer, etc.)

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Phone Number/ Fax

E-mail Address

Date Questionnaire Completed

4. QUESTIONNAIRE: (Contracting/Ordering Activity must fill in.)

a. DESCRIPTION OF WORK Please check () all applicable box(es) in the following table if your requirement includes/included any of the listed work elements. Please also provide a brief description of your requirement.

FACILITIES

Operation

Maintenance

Repair

Boiler Plants

Chillers Plants

Heating Plant

Co-generation Plant

Distribution Systems (natural gas, steam, hot water, chilled water, etc.)

Absorption type chilled water generator systems

Absorption type hot water generator systems

Auxiliary equipment/systems of cooling/heating/domestic hot water in the mechanical rooms in various buildings

Brief Description of Work

b. RATING Referring to the following rating scale, please circle the rating to each question that most accurately describes the contractor’s performance or situation. Please also provide brief comment/explanation to your evaluation as much as possible.

RATING SCALE

Exceptional (E)

Performance meets contractual requirements and exceeds many to the customer’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

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Very Good (VG)

Performance meets contractual requirements and exceeds some to the customer’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory (S)

Performance meets contractual requirements. The contractual performance of the element or sub-element being evaluated contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal (M)

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory (U)

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-elements being assessed reflects a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Not Applicable

(NA)

The statement is not applicable.

(1) Did the service provided by this contractor meet the performance work statement, specifications, etc. of your contract?

E VG S M U NA

(2) How effective were the contractor’s quality control and/or inspection procedures?

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(3) Did the contractor submit required documentation (work schedule, reports, data, etc.) in a timely manner?

(4) Were the above-mentioned submittals adequate to support the contract work?

(5) Did the contractor adhere to the work schedule?

(6) How was the effectiveness of the contractor’s job site supervision?

(7) Did the contractor retain managers/supervisors with the technical and administrative abilities needed to meet contract requirements?

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(8) Did the contractor’s key personnel meet the qualifications as required in the contract?

(9) Did the contractor always hire and retain a sufficient number of employees for the performance of the contract work?

(10) Was the contractor able to solve contract performance problems without extensive guidance from your procurement or technical personnel?

(11) How well did the contractor substantiate pricing data for change orders/modifications if there were any?

(12) During the performance of the contract work, did the contractor respond to any immediate maintenance/repair request in a timely manner if there were any?

(13) If a warranty issue arose, did the contractor provide timely assistance?

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(14) How was the contractor’s compliance with laws and regulations?

(15) Would you hire this contractor again? Yes No

(16) Overall Rating E VG S M U NA

Note: The contracting/ordering activity may be contacted for additional information pertaining to past/ present performance of the contract being evaluated. Your understanding and cooperation are greatly appreciated.

Your corporation is highly appreciated.

Please fax or e-mail the completed questionnaire to:

374 CONS/LGCAB

Unit 5228, Bldg 620 Yokota Air Base Fussa-shi Tokyo 197-0001

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Attn: A1C Sherry Rhoden Fax: 042-551-0973 Tel: 042-551-6120

DSN 225-7399

E-mail To: sherry.rhoden@us.af.mil