Atch 10 FA8501-11-R-0017.doc

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

FA8501-11-R-0017

ATTACHMENT #10

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Contract Administrator, Inspector, Project Engineer, Quality Assurance Evaluator, Other-explain):

Agency or Business:

Telephone:

Fax Number:

RETURN YOUR COMPLETED QUSTIONNAIRE VIA FAX NUMBER AT (478-327-3061). TO ENSURE PROPER HANDLING OF THE INFORMATION, PLEASE CALL MRS. ANGIE WHITLEY (478-926-7989) BEFORE TRANSMITTAL.

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE RELEASED TO THE OFFEROR.

PART 1. PROGRAM INFORMATION:

Contractor/Business:

Program Description: (Description of Project Scope of Work)

Contractor’s Role in the Program:

____Prime ____Subcontractor ____Vender/Supplier

Contract Number:

Number of Years?: Basic: _____ Option:_____

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, Etc.

Total Contract Amount: $ Status: ( ) Active ( ) Completed

Date of Award:

If completed, date of completion:

If Award Fee Contract, what percentage of the fee has been awarded in each of the last 3 years?

Note: In Part II, should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 3 of 3.

PART II. PERFORMANCE ASSESSMENTS:

Please check the appropriate rating for each of the following questions:

N/A=Not Applicable – Self-explanatory. U=Unsatisfactory – Performance did not meet most contractual requirements. M=Marginal – Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective. S=Satisfactory – Performance met contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. V=Very Good – Performance met all contractual requirements and exceeded some to the customer’s benefit. E=Exceptional – Performance met all contractual requirements and exceeded many to the customer’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

17. During the contract, did the contractor change any of the original subcontractors?

( ) Yes ( ) No

If Yes, please explain.

18. Were you satisfied with the contractor’s coordination and management of multiple technicians simultaneously? Please explain. ( ) Yes ( ) No ( ) N/A

19. Has action been initiated to cancel or terminate the contract for default?

( ) Yes ( ) No

If Yes, please explain.

20. Has there been any dispute/claim relative to the contract?

( ) Yes ( ) No

If Yes, Please explain.

21. Describe the contractor’s or company’s strong characteristics.

221. Describe the contractor’s or company’s weak characteristics.

23. If given a choice, would you award to this contractor again?

( ) Yes ( ) No

242. Additional Remarks: