FA665609R0005Atch5PastPerQues.doc

Solicitation #FA6656-09-R-0005, Construct Addition/Fire Suppression B104, Attachment 5 Page 2 of 5 Pages CONTRACTOR’S NAME: __________________________ CONTRACT NUMBER: _________________________

RESPONDER FIRM AND POC Names:______________________________________________________________

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE – CONSTRUCTION CONTRACTS

SECTION A: CONTRACTOR INFORMATION: (To be completed by the contractor prior to mailing to reference)

a. Contractor’s name and address: ____________________________

b. Point of Contact: ____________________________

c. Phone #: _______________________

d. Contract #: _____________________

Contract Type: _______________________

e. Project Title: ____________________________________________________________

f. Performance Period: ______________________

g. Authorization is hereby given to provide the information in SECTION B of this questionnaire.

(Signature of authorized contractor representative.)

(Date)

(Printed name and title of authorized contractor representative.)

SECTION B: PERFORMANCE INFORMATION: (To be completed by the Present/Past Evaluation Respondents)

a. Respondent’s name and address: ____________________________

b. Respondent’s Point of Contact: ________________________

c. Phone #: ___________________________

d. Contract #: _____________________

Contract Type: _______________________

e. Award Amount: _________________

Final Amount: _________________

f. Performance Period: ______________________ Date of Completion (If applicable): ____________

g. Authorization is hereby given to provide the information in SECTION B of this questionnaire.

Please mail, fax, or email the completed questionnaire to:

910 MSG/CONF

Attn: Phyllis J. Delgros

YOUNGSTOWN AIR RESERVE STATION

3976 KING GRAVES ROAD – UNIT 31

VIENNA OH 44473-5931

Phone: (330) 609-1046 DSN: 346-1046

FAX: (330) 609-1042 DSN: 346-1042

Email: phyllis.delgros@youngstown.af.mil

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.

Performance meets contractual requirements with many exceeded to the Government’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 the Government’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.

Please provide explanatory comments for any area/factor/subfactor rated less than satisfactory.

1. QUALITY CONTROL: RATING

a. Quality of Workmanship

b. Proper provision, use and storage of materials

c. Adequacy of submittals

d. Adequacy of as-built drawings

e. Identification/correction of deficient work in a timely manner

f. Initiative to suggest and implement solutions

2. TIMELY PERFORMANCE

a. Provided submittals in a timely manner

b. Submittals were well researched and clearly identified the proposed item

c. Submittals accurately matched contract requirements

d. Developed realistic progress schedules

e. Complied with established/approved progress schedules

f. Submission of updated and revised progress schedules

g. Resolution of performance delays

h. Completion of work, including punchlist items within performance period

3. MANAGEMENT EFFECTIVENESS

1. Provided experienced project managers/supervisors with the technical and administrative abilities needed to ensure compliance with contract requirements and safety regulations.

2. Site Manager/Superintendent had sufficient authority to make decisions or take action during project performance. Superintendent was consistently present on site while work was being performed and acted promptly to resolve probems and ensure work quality.

3. Subcontracted with experienced, knowledgable subcontractors

4. Paid subcontractors/supliers in a timely manner.

5. Effectively managed subcontractors.

6. Provided accurate, complete, reasonable, well-substantiated pricing data for modifications (not over inflated or under estimated).

7. Received timely and satisfactory responses to warranty issues after project completion.

8. Cooperated to resolve problems, attended meetings as scheduled and maintained communication to assure satsifactory resolution.

9. Provided proposals that accurately represented the work required.

10. Completed all contract work prior to requesting final inspection. Left no major discrepancies.

11. Completed all contract requirements, including final site cleanup, submittal of O&M

Manuals and warranties, and punchlist items by the required completion date.

12. Promptly submitted closeout documentation and final invoice after completion and acceptance of the project/contract.

4. COMPLIANCE WITH LABOR STANDARDS

a. Submitted complete and correct prime contractor payroll reports in a timely manner.

b. Ensured subcontractor payrolls were complete, correct and submitted in a timely manner.

c. Complied with labor laws and regulations, with specific attention to the Davis-Bacon Act.

5. COMPLIANCE WITH SAFETY AND OTHER STANDARDS

a. Timely prepared, submitted and implemented/enforced an adequate Safety & Health Plan

b. Timely prepared, submitted and implemented/enforced an adequate Environment Protection Plan/Sediment & Erosion Control Plan.

c. Timely prepared, submitted and implemented/enforced an adequate Waste/Recyling Plan.

d. Timely prepared, submitted and implemented/adhered to an adequate Work Plan, including work schedule.

Other Past Performance Considerations:

1. Were liquidated damages assessed? (If so, describe the frequency, circumstances, severity of problem etc.)

(Yes No)

2. Based on the contractor's overall performance, would this contractor (Yes No) be re-hired?

3. Were there any indications of financial/bonding difficulties of this (Yes No)

Contractor?

4. Did the Contractor display any unique skills or accomplishments?

(Yes No)

5. Was this Contractor issued any provessional/industry awards, letters of (Yes No)

Appreciation/commendation, etc., by your agency?

6. Did this Contractor successfully submit any value engineering change

(Yes No) proposals? If yes, what was the impact on reducing cost or schedule, increasing efficiency or improving quality?

EXPLANATION OF RATINGS AND ADDITIONAL REMARKS/COMMENTS:

(utilize additonal pages, if needed) Name of Evaluator ________________________________________________________

Organization _____________________________________________________________

Phone Number ______________________________________

Date of Involvement in Contract ________________________

Date Questionnaire Completed _________________________

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104