Security_Past_Performance_Questionnaire.pdf

ATTACHMENT 4

FA5531-12-R-0001

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

SECTION A: CONTRACTOR INFORMATION

1. Contractor’s Name and Address:

2. Point of Contact:

3. Phone Number:

4. Contract Number: Contract Type:

5. Project Title:

6. Period of Performance:

SECTION B: RESPONDENT INFORMATION (To Be Completed By Evaluation Respondent)

1. Respondent’s Company Name & Address:

2. Respondent’s Name:

3. Phone Number: Fax Number:

E-Mail:

4. Contract Number: Contract Type:

5. Award Amount: Final Amount:

6. Project Title:

7. Period of Performance:

SECTION C: FAX or Email COMPLETED QUESTIONNAIRE FORM TO: 425 Air Base Squadron, Ismet Kaptan Mahallesi, 1385 Sokak, Izmir, Turkiye. Attention: Mr Cuneyt Kuey, cuneyt.kuey@izmir.af.mil or TSgt Thomas A. Adams, thomas.adams@izmir.af.mil or fax number: (232) 489 3918.

THIS FORM MUST BE RETURNED NO LATER THAN: 7 November 2012, 1100 A.M. local time.

mailto:cuneyt.kuey@izmir.af.mil mailto:thomas.adams@izmir.af.mil

SECTION D: PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

1 2 3 4 5 6

Unsatisfactory Marginal None Satisfactory Very Good Exceptional

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginally effective.

No record of past performance or the record is inconclusive.

Performance met contract requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner

1. Provided experienced superintendent, managers, and supervisors, with 1 2 3 4 5 6 N/A the technical and administrative abilities to meet requirements.

COMMENTS/REMARKS:________________________________________________________________________

2. Adequately controlled performance of contractors. 1 2 3 4 5 6 N/A

3. Provided effective quality control plan which resulted in a quality service. 1 2 3 4 5 6 N/A

4. Identified problems as they occurred. Suggested approaches to resolving problems. 1 2 3 4 5 6 N/A Displayed initiative and cooperation in solving problems.

5. Were there any verbal/written complaints against the employees of the contractor? YES NO (If Yes, briefly explain the circumstances)

6. Based on the contractor’s overall performance, would you rehire this contractor? YES NO

OVERALL PERFORMANCE RATING ___________________________________________________

Signature of Rater: ________________________________________________________ Date: ________________