Atch_3_-_Past_Performance_Survey.pdf

FA700017R0043

Past Performance Survey

Attachment 3

MEMORANDUM FOR _______________________________________

SUBJECT: Request for Past Performance Evaluation

FROM: 10 CONS/PKA

8110 Industrial Drive, Suite 200 USAF Academy, CO 80840

1. You have been identified as a point of contact for a past performance evaluation of the firm identified on the attached survey. This firm is currently interested in providing difficult tree removal and overstory thinning services to the United States Air Force Academy, CO.

2. Please complete the attached survey questionnaire. You may email the survey to heidi.stein.2@us.af.mil or carol.mohr@us.af.mil. Documents may also be faxed to my attention at 719-333-6608.

3. Your contribution and prompt attention to this questionnaire is greatly appreciated. To be considered timely, responses MUST be received no later than 1:00 PM Mountain Time on 19 May 2017. If you have any questions, please contact Heidi Stein, at 719-333-8049.

Carol Mohr Contracting Officer

Attachment:

Past Performance Survey mailto:heidi.stein.2@us.af.mil mailto:carol.mohr@us.af.mil

** FOR GOVERNMENT USE ONLY ONCE COMPLETED **

PAST PERFORMANCE SURVEY

This attachment will not be incorporated into the resultant contract.

THIS DOCUMENT, WHEN COMPLETED, IS ONLY FOR VIEW BY THE GOVERNMENT.

This survey is for the United States Air Force Academy Contracting Office.

10th Contracting Squadron Phone: 719-333-8049 Fax: 719-333-6608

Brief Description of Services to be Required: Removal of Hazardous Trees, Difficult Tree Removal, Overstory Thinning, and Slash Disposal

I. CONTRACT INFORMATION:

(Quoter will fill out Section I before sending the survey to the respondent.)

Contractor’s Name: ___________________________________________________________________ Address: ____________________________________________________________________________ Telephone Number: ___________________________________________________________________ Point of Contact: _____________________________________________________________________ Project Title or Brief Description of Work: _________________________________________________ Contract Number: ____________________________________________________________________* Contract Value Per Year: _______________________________________________________________ Requirement Provided Per Contract: ______________________________________________________ Contract Period or Dates of Performance: _________________________________________________*

*Note: If quoter holds or has held more than one contract with the agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

II. SURVEY RESPONDENT INFORMATION:

Complete the following information on your company. You may be contacted for additional information pertaining to the past or present performance of the contractor identified in the section above. (The following information will assist in the analysis of the data. Information will be kept confidential.)

Name of Respondent: __________________________________________________________________ Company/Organization: ________________________________________________________________ Title: _______________________________________________________________________________ Address: _____________________________________________________________________________ Telephone Number: ___________________________________ Email: __________________________ Relationship and time involved with Program/Contract:

Date you completed this questionnaire: ____________________________________________________

III. PERFORMANCE INFORMATION:

Choose the description of the contractor’s work that best reflects their performance using the descriptions provided below. Please provide a narrative explanation for any ratings of unsatisfactory, marginal, very good or exceptional and any other specific problems or annotations that would help us evaluate the contractor.

E VG S M U N/A

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable The contractor met and exceeded many of the requirements of the contract and consistently performed at a superior level.

Performance was accomplished with very few minor problems, and the contractor took immediate and effective corrective actions for those problems that did occur.

The contractor met and exceeded some of the requirements of the contract and consistently performed very well.

Performance was accomplished with some minor problems, and the contractor took timely and effective corrective action for those problems that did occur

The contractor met the requirements of the contract and consistently performed at an acceptable level.

Performance was accomplished with some problems, and the contractor took effective corrective action for those problems that did occur

The contractor did not always meet some of the requirements of the contract and intervention was required to continue performance.

There were instances where performance was at a less than acceptable level;

performance was accomplished with some problems and some corrective actions appear only marginally effective or were not fully implemented

The contractor did not meet the requirements of the contract and performance was at an unacceptable level. There were a number of serious problems that required extensive oversight and involvement, and corrective actions were either ineffective or non-existent

Unable to provide a rating.

Contract did not include performance for this aspect, or information is not available. Do not know.

PLEASE ANSWER ALL QUESTIONS. PLEASE PROVIDE ADDITIONAL COMMENTS FOR

EACH QUESTION.

QUALITY

1 Rate the contractors overall performance in terms of quality of service and product?

COMMENTS:

2 Were there any quality issues? If so, explain how the contractor resolved the issue(s).

3 Demonstrated an effective quality control and/or inspection procedures to meet contract requirements.

DELIVERY

4 Did the contractor deliver on time or ahead of schedule?

BUSINESS RELATIONS

5 Did the contractor keep you informed of any problems as they occurred and suggest solutions to the problem?

OVERALL

6 Were there any negative performance aspects of the contractor?

If yes, please comment.

YES NO

7. ADDITIONAL COMMENTS:

Thank you for completing this survey.

The completed survey is to ONLY be viewed by the Government. Do not submit a copy of the completed survey to anyone other than Heidi Stein, Contract Specialist, or Carol Mohr, Contracting Officer.

FAX or E-MAIL COMPLETED SURVEY FORM TO:

FAX: ATTN: Heidi Stein, Contract Specialist, or Carol Mohr, Contracting Officer, 10 CONS/PKA, FAX (719) 333-6608

EMAIL: heidi.stein.2@us.af.mil or carol.mohr@us.af.mil

****FOR OFFICIAL USE ONLY, ONCE COMPLETED****

mailto:heidi.stein.2@us.af.mil mailto:carol.mohr@us.af.mil