Attachment 5- Past Performance Questionnaire.docx

Section 1 : Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., (Firm Fixed Price (FFP), Fixed Price Incentive (Firm Target) (FPIF), Cost Plus Incentive Fee (CPIF), Cost Plus Fixed Fee (CPFF), etc.):

E. Program Title:

F. Brief Program Description:

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

H. Period of Performance

3. Reason for difference (if applicable):

I. Contract 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

Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 2 : Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

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

Attachment 4: Past Performance Questionnaire

For Official Use Only

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands, please state location):

Section 3 : Respondent Identification A. Respondent’s name:

B. Respondent’s title:

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

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

E. Other suggested points of contact:

Section 4 : Performance Information

In the table 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:

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.

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

SUPPORTING INFORMATION:

2. Delegated authority to project managers and supervisors commensurate with contract requirements.

3. Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

4. Provided a sufficient number of qualified personnel to meet contract requirements?

5. Followed approved quality control plan. SUPPORTING INFORMATION:

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

8. Provided timely resolution of contract discrepancies. SUPPORTING INFORMATION:

9. Identified problems as they occurred. SUPPORTING INFORMATION:

10. Suggested alternative approaches to problems. SUPPORTING INFORMATION:

11. Displayed initiative to solve problems. SUPPORTING INFORMATION:

12. Met established mobilization plan. SUPPORTING INFORMATION:

13. Was responsive to contract changes. SUPPORTING INFORMATION:

14. Provided adequate project supervision. SUPPORTING INFORMATION:

15. Provided accurate and complete line-item cost proposals including all aspects of work required for each task.

16. Cooperated and communicated with government/company personnel after award.

17. How would you rate the contractor's overall performance on this contract? SUPPORTING INFORMATION:

18. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain.

EXPLANATION:

Yes No

20. Has the contractor managed at least two (2) separate regions simultaneously? A region is a geographical area that includes multiple sites)

EXPLANATION:

Yes No

22. Has the contractor provided services for a minimum of 290 Front End Loaders and a minimum of 1.2 million liters of liquid waste?

EXPLANATION:

Yes No

23. Has the contractor performed a full range of refuse maintenance services of the scope of the PWS (to include the management of subcontractors)?

EXPLANATION:

Yes No

24. Does the contractor use subcontractors? If yes, has the performance experienced any gaps in service or had any issues? Please state the issues (if applicable).

EXPLANATION:

Yes No

25. Is the contract annual dollar value worth a minimum of £4,000,000 ($5,380,000)? If no, please state the estimated value.

EXPLANATION:

Yes No

26. Has the contractor displayed a high turnover of employees or displayed signs of employee retention issues?

EXPLANATION

Yes No

Additional remarks:

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to: 48CONS.PKB.Refuse@us.af.mil image4.png image5.png image1.png image2.png image3.png image6.png