Past Performance Questionnaire - Attachment 3.pdf

Attachment - 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

FA6703-09-R-0011

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a C-130 Aircraft Wash contract at Dobbins ARB, Georgia.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at (678) 655-4983.

CYNTHIA WEAVER-WASHINGTON

Contracting Officer

1 Attachment

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor’s Name: ____________________ Telephone Number: ____________________

Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: _________*

Contract Period or Dates of Performance Provided by Offeror: _______________________*

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

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. INSTRUCTIONS FOR COMPLETED QUESTIONNAIRE. Once you have completed your portion of the questionnaire you then need to forward it to the 94 th

Contracting Office, ATTN: Kim Armstead, before the Offer Due Date and Time. It is preferred that you forward this via electronic means to kim.armstead@dobbins.af.mil . It is advised that you use return receipt. The 94 th

Contracting Office should receive the completed questionnaire directly from the Reference. Printed hard, typed or hand-written copies will be accepted via mail or Fax. Fax completed survey form to: 94 th

Contracting Office, Attn: Kim Armstead, at 678-655-3418 or mail to: 94 th

Contracting Office, 1538 Atlantic Avenue, Bldg. 812, Dobbins ARB, Georgia

30069.

mailto:kim.armstead@dobbins.af.mil

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 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.

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.

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. Overall rating of contractor’s ability to perform exterior aircraft washes.

2. Overall rating of contractor’s ability to perform interior aircraft washes.

3. Ability to meet specific response time and scheduled time-frames for completion of aircraft washes.

4. Compliance with contractual terms and conditions

5. How well does the contractor respond to short-notice requirements?

6. Responsiveness/Timeliness for providing reports/documents required by the contract.

7. Does the contractor maintain the proper certifications/licensing required for aircraft washing?

The contractor: E G S M U N

8. Ability to identify problems, potential problems, and promptly notify the contracting officer

9. Ability to correct problems and prevent or mitigate potential problems in a timely manner

10. Ability to use effective approaches and provide technical expertise and resources to solve contract problems

11. Working relationship with Contracting Officer, Quality Assurance

Personnel, and Customers

12. Overall rating of customer satisfaction

13. Overall rating of business relations

14. Ability to select and retain personnel with the ability, skills and qualifications to perform aircraft washing

15. Ability to select and retain cooperative and effective key personnel, such as the contract manager and quality control personnel

16. Extent key personnel were knowledgeable about contractual requirements

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

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

YES/NO

19. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

20. Is the contractor rated in CPARS? YES/NO

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

Remarks:______________________________________________________________________