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EXHIBIT D
| FA7022-12-R-0005 |
| EXHIBIT D |
| FA7022-12-R-0005 |
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
SUBJECT: Request for Past Performance Evaluation
TO:
You have been identified as a point of contact for a past performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for an operations and maintenance services contract at Patrick AFB, FL.
Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at phone_____________________.
Signature
1 Atch 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/Type:_______________________________________________________ Period of Performance _________________________________________________________ Original Contract $ Value:_______________________________________________________
Current Contract $ Value:________________________________________________________
Reasons for differences between original contract value and current contract value: __________
B. RESPONDENT INFORMATION:
The following information will assist in the analysis of data. Information will be kept confidential.
Name of Respondent: _____________________ Title: ____________________________
| Address: _____________________ | Telephone Number: ___________________ _____________________________ | Fax Number: | _____________________ |
| _____________________________ | Email Address: _____________________ | | |
C. EMAIL OR FAX COMPLETED SURVEY FORM TO:
Michelle Raines; Email: michelle.raines@us.af.mil; Fax: 321-494-5403
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.
| Exceptional |
| Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Neutral |
Performance meets/met 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/met 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/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. |
| Performance does not meet/did 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/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. |
Performance was not observed or not applicable to the current effort being reported against.
Place an “X” in the appropriate column using the definitions matrix above.
| The contractor: |
| E |
| G |
| S |
| M |
| U |
| N |
| 1. |
| Overall performance in planning/managing the effort. |
| 2. |
| Overall consistency, quality, and reliability of performance. |
| 3. |
| Effectiveness in maintaining continuity of mission support while transitioning/phasing-in sources and personnel. |
| 4. |
| Adherence to required deliveries of technical data, documents, and software submitted in accordance with contractual specifications. |
| 5. |
| Potential problems/delays are communicated to the customer in time to mitigate impact to schedule. |
| 6. |
| Compliance with contract terms and conditions. |
| 7. |
| Working relationships (both management and technical) with government and/or other contractor personnel. |
| 8. |
| Ability to comply with security requirements. |
| 9. |
| Managing and resolving problems. |
| 10. |
| Ability to meet or exceed small business goals set forth in the approved subcontracting plan. |
| 11. |
| Ability to keep personnel current with state-of-the-art technology. |
| 12. |
| Ability to recruit and retain a qualified staff to meet contractual requirements. |
| 13. |
| Ability to obtain and maintain required personnel security clearances. |
| 14. |
| Demonstrated ability to maintain inventory control of government-furnished equipment. |
| 15. |
| Responsiveness to contract changes. |
| 16. |
| Provided adequate project supervision. |
| 17. |
| Paid subcontractors/suppliers in a timely manner. |
| 18. |
| Provided accurate and complete line item cost proposals including all aspects of work required for each task. |
| 19. |
| Cooperated with Government personnel after award. |
| 20. |
| How would you rate the contractor’s overall perfomance? |
| 21. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
YES/NO
| 22. |
| Would you award another contract to this contractor? If not, explain in “remarks.” |
YES/NO
| 23. |
| Is the contractor rated in CPARS? |
| YES/NO |
Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
| _______________________________ | ______________________________ | |
| Evaluator’s Signature | | Date |
Source Selection Senstive IAW FAR 2.101 and FAR 3.104