Past Performance Questionnaire Command Post.docx

FOR OFFICIAL USE ONLY FA6712-15-R-0004

SOURCE SELECTION SENITIVE

IN ACCORDANCE WITH FAR 3.104

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

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE – CONSTRUCTION CONTRACTS

SECTION A: CONTRACTOR INFORMATION: (To be completed by offeror prior to sending to reference provider)

Address:

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

Printed Name and Title of Authorized Contractor Representative

Instructions to respondents: Thank you for taking the time to fill out this past performance questionnaire. Please fill out the questionnaire and send back within the time frame the contractor has requested (this is TIME SENSITIVE and may adversely affect past performance rating, if not sent back timely). Please answer all questions honestly and accurately.

When completed, please mail, fax, or email to:

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”. 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.

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

Address:

Award Amount:

Final Amount:

Date of completion:

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

Printed Name and Title of Authorized Respondent Representative

RESPONSE SECTION

U

N

U

N

U

N

U

N

U

N

U

N

U

N

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

U

N

U

N

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

A

U

N

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

A

U

N

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

A

U

N

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

A

U

N

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

A

U

N

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

A

U

N

U

N

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

A

U

N

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

A

U

N

1.

Were payrolls submitted timely?

A

U

N

U

N

A

U

N

A

U

N

A

U

N

U

N

Please include any additional comments as appropriate:

Do you know of any similar projects the company has completed or is in progress with, if so please provide agency and location?

Location:_____________________________________________________________________________

Please circle the most applicable:

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.

Evaluator’s Signature:___________________________________________________________________

Evaluator’s Duty Title:___________________________________________________________________

Date: ________________________________________________________________________________