Attachment_4_-_New_Saber_-_Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY FA6670-14-R-0001

SOURCE SELECTION SENITIVE ATTACHMENT 4

IN ACCORDANCE WITH FAR 3.104 AND 2.101

4 February 2014 Page 1 of 8

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE –

CONSTRUCTION CONTRACTS

When filled in, this document become Source Selection Sensitive in accordance with FAR 3.104 and 2.101

SECTION A: CONTRACTOR INFORMATION: Offeror complete pages 1-2 below. Reference shall complete pages 3-8.

1. Contractor (Name, Address, and Zip code):

2. Point of Contact _______________________________________________________________

3. Phone Number / E-mail Address: ___________________________________________________

4. Contract Number: ________________________________________________________________

5. Program/Project Title: _____________________________________________________________

6. Type of Contract: Fixed Price ____ Cost Reimbursement ____ Other ____ (Explain)

7. Performance Period: ______________________________________________________________

8. Date of Award: ____________________________________________________________________

9. Description, location, and relevancy of work (i.e., focusing on repair, replace, and installation of roofs)

10. Brief description of effort: Prime ____ or Subcontractor ____

11. Complexity of Work: Difficult _______ Routine _______

12. Original Contract Dollar Value: ________________________________________________________

13. Current/Completed Contract Dollar Value: _______________________________________________

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14. If amounts for 10 and 11 above are different, provide a brief explanation for the reason.

15. Contract Completion Date (including extension): _________________________________________

16. Type and Extent of Subcontracting: ____________________________________________________

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

Signature of Contractor Authorized Representative Date

Printed Name and Title of Authorized Contractor Representative

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Instructions to respondents: You have been provided as a reference in response to the solicitation (FA6670-14-R-0001) for Simplified Acquisition of Base Engineering Requirements (SABER) Indefinite- Delivery Indefinite-Quantity contract at the Niagara Falls Air Reserve Station, Niagara Falls, NY. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to 914 CONF/LGC in accordance with the instructions listed below.

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

Please answer all questions honestly and accurately.

Prior to completing the following questionnaire, please review pages 1& 2 to ensure accuracy. Thank you for taking the time to fill out this past performance questionnaire.

RESPONSE DATE: 13 JUNE 2014

When completed, please mail or email to:

914 CONF/LGC

Mary E Pyle Platts phone: 716-236-2215 (DSN 238) Bldg 800 Rm 226 2720 Kirkbridge Dr. *email: mary.pyleplatts@us.af.mil Niagara Falls, NY 14304-5001 *MS Word (*.docx) or Adobe readable (*.pdf) format only

SECTION B: PAST PERFORMANCE QUESTIONNAIRE (TO BE COMPLETED BY THE

RESPONDENT)

1. RESPONDENT/GOVERNMENT OFFICIAL’S INFORMATION

NAME: __________________________________________________________________

POSITION/TITLE: _________________________________________________________

ADDRESS: _______________________________________________________________

PHONE: _________________________ E-MAIL: _______________________________

2. RELATIONSHIP TO CONTRACTOR AND TIME KNOWN:

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When responding to the following statements, rate the contractor by selecting the rating below that most accurately describes the contractor’s overall performance for each element (Quality Control, Timely Performance, etc…). If the statement is not applicable, then circle “N”.

For any Unacceptable rating, please provide explanatory narratives in the remarks block. These narratives needs not be lengthy, just detailed. If more space is needed, use the back of the questionnaire or attach additional pages. Be sure to identify your continued narration with the respective line number.

The letters correspond to the following:

(A) Acceptable: Performance meets/met 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.

(U) Unacceptable: Performance does not meet/did 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.

(N) Neutral: Performance was not observed or not applicable to the current effort being reported against.

RESPONSE SECTION

A. Quality Control

1. Was the quality of the workmanship sufficient? A U N

2. Were the as-built drawings accurate and timely submitted? A U N

3. Was identification/correction of deficient work accomplished timely? A U N

ADDITIONAL COMMENTS: __________________________________________________________________

B. Timely performance

1. Were submittals provided on time? A U N

2. Did the submittals clearly identify the proposed item? A U N

3. Were progress schedules realistic? A U N

4. Were progress schedules met? A U N

ADDITIONAL COMMENTS: __________________________________________________________________

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C. Management Effectiveness

1. General Business Practices

a. Were experienced managers/supervisors provided who possessed the technical and administrative abilities necessary to manage the project and meet contractual requirements?

A U N

b. Were experienced subcontractors hired? A U N

c. Were subcontractors/suppliers paid timely? A U N

d. Was all contract work completed prior to requesting a final inspection, with no major deficiencies?

e. Were timely and satisfactory responses to warranty issues provided after project completion?

f. Did the contractor cooperate to resolve problems, attend meetings (as applicable) and maintain effective communication to ensure satisfactory resolution?

2. Pricing

a. Were price proposals submitted timely accurately representing the required work?

b. Was accurate, complete and reasonable supporting pricing information provided for modifications/change orders (not overinflated or underinflated)?

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3. Site Management/Superintendence

a. Did the site Manager/Superintendent have sufficient authority to make decisions or take action during project performance?

b. Was he/she consistently on site while work was being performed? A U N

c. Did he/she ensure compliance with contract and safety requirements?

d. Was prompt action taken by him/her to resolve problems with work quality?

D. Compliance with Labor Standards

1.

Were payrolls submitted timely?

2. Were payrolls completed and accurate? A U N

3. Was the contractor compliant with all labors laws and regulations, with specific attention to the requirements of the Davis-Bacon Act?

E. Compliance with Safety Regulations

1. Were workplace safety standards and regulations (OSHA, Federal, State, Local and Agency) met?

2. Did the contractor submit and implement/enforce an adequate health and safety plan?

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F. Compliance with Environmental and Other Standards

1. Did the contractor submit and implement an adequate environmental pollution control plan? (Including, but not limited to recycle and disposal of waste material, hazardous waste management and/or sediment and erosion control.)?

Other Past Performance Considerations

1. Assessment of liquidated damages (frequency, circumstances, severity (Yes No) of problem etc.)

2. Was the contractor cooperative in negotiating modifications so that (Yes No) they would result in fair and reasonable cost adjustments to the contract?

3. The contractor provided all deliverables (including documentation) in (Yes No) a timely and accurate manner.

4. Have there been any labor disputes or violations of public law? (Yes No)

5. Have there been any indicators that the contractor has had any (Yes No) financial difficulties?

6. Contractor submitted modifications and other required proposals in a (Yes No) timely manner.

7. Was the contractor ever issued a Cure or Show Cause Notice (Yes No) under the referenced contract? If yes, explain outcome in “Additional Comments”

Please include any additional comments as appropriate:

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Please circle the most applicable statement below:

1. I would enter into another contract with this contractor.

2. I might enter into another contract with this contractor.

3. I would not enter into another contract with this contractor.

Signature of Evaluator Date

Printed Name and Title of Evaluator

THANK YOU FOR YOUR TIME AND QUICK RESPONSE.