Atch_4_PPQ.pdf

Attachment 4

FA5613-18-R-0006

For Official Use Only

PAST PERFORMANCE QUESTIONNAIRE

This Acquisition is for Cleaning of Hoods and Ducts in Dining Facilities in the Kaiserslautern Military Community.

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address:

Telephone Number: ____________________

Email Address: ____________________

Point of Contact: ____________________

Project Title or Brief Description of Work*:

Contract Number*: Contract Amount:

Contract Period or Dates of Performance*:

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

To be completed by the respondent and returned directly to the contracting office.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Name of Respondent: _____________________

Title: _____________________ Title: _____________________

Address: _____________________ Address: _____________________

Telephone Number: _____________________ Telephone Number: _____________________

Email Address: _____________________ Email Address: _____________________

C. RETURN COMPLETED SURVEY FORM WITHIN 4 WORKING DAYS AFTER RECEIPT TO:

SSgt Jasmine Karingithi/Contract Specialist Ray Neal/Contracting Officer 700 CONS/PKA and 700 CONS/PKA jasmine.karingithi@us.af.mil marion.neal@us.af.mil +49-631-536-3825 or DSN 489-3825 +49-631-536- 8080 or DSN 489-8080 mailto:%20jasmine.karingithi@us.af.mil mailto:marion.neal@us.af.mil

CONTRACTOR’S NAME: CONTRACT NUMBER:

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to your organization’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements.

The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element 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.

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

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: CONTRACT NUMBER:

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

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

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

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

4. Followed Government accepted Quality Control Plan.

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

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

7. Provided timely resolution of contract discrepancies.

8. Identified problems as they occurred.

9. Suggested alternative approaches to problems.

10. Displayed initiative to solve problems.

11. Provided timely resolution of defects.

12. Was responsive to contract changes.

13. Provided adequate project supervision.

14. Complied with environmental requirements.

15. Did contractor consistently respond within the required time frames?

16. Did contractor assign personnel with required skills to accomplish the work?

17. Cooperated with Government personnel after award?

18. How would you rate the contractor's overall performance?

19. How many elevators and escalators have been serviced under this contract? Qty:

20. Did the contractor follow DIN EN 13015 Instandhaltung von Aufzuegen und Fahrtreppen –

Regeln fuer Instandhaltungsanweisungen / Maintenance for Lifts and Escalators – Rules for Maintenance Instructions perform

YES /NO

21 Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain outcome in “remarks.”

YES / NO

22. For US Government contracts only: Is the contractor rated in CPARS? YES / NO

23. Would you award another contract to this contractor? If not, explain in “remarks.” YES / NO

Remarks: