ATTACHMENT5_PastPresentPerformanceQuestionnaire.pdf

RFP FA8519-12-R-00516

ATTACHMENT 5

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

463L Pallet Repair/Production

(This questionnaire, when filled in, shall be treated as Source Selection Sensitive in accordance with FAR 3.104-3 AND 2.101 and shall not be disclosed to anyone outside of the Government Source Selection Team.)

PLEASE PROVIDE THE FOLLOWING INFORMATION:

Name/Signature of Respondent and Role Relative to Contract (e.g. Buyer, Program Manager):________________________________________________________ Agency or Business: ______________________________________________________________________________________________________ Address: _______________________________________________________________________________________________________________ Telephone No. _______________________________ FAX No. ____________________________________

RETURN YOUR COMPLETED QUESTIONNAIRE VIA FAX TO (478) 222-1854 OR ELECTRONICALLY MAIL TO DONNA.PALLINI@ROBINS.AF.MIL AND MANDY.MATHEWS@ROBINS.AF.MIL. PLEASE CALL (478) 222-1892 or -1754 BEFORE

TRANSMITTAL TO ENSURE CONFIDENTIALITY.

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

PART I. SPECIFIC PROGRAM INFORMATION:

Contractor/Business: _____________________________________________ CAGE Code: __________

Program Title and Brief Description: _____________________________________________________________________________________

Contractor’s Role in the Program: _____Prime _____Subcontractor _____Vendor/Supplier

Contract Number: ________________________________ Number of Years: Basic:________ Option: _________

Contract Type(s): i.e. Firm-Fixed-Price, Time & Materials, Cost, etc.:

Competitive Contract? Yes _____ No _____

SOURCE SELECTION INFORMATION – SEE FAR 3.104

FOR OFFICIAL USE ONLY

PART II. GENERAL PROGRAM INFORMATION:

Period of Performance of Contract or Effort: Beginning Date _______________ through _______________ Have there been any changes to the original Schedule? _______________________________________________________________________

Contract Dollar Value:

1. Original Contract $ Value (assuming all options exercised):________________________________________________________

2. Current $ Value (assuming all options exercised): ________________________________________________________________

3. Primary Causes of Changes: ______________________________________________________________________________________

NOTE: In Part III, should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 3 of 4. Unsubstantiated “very good” and “exceptional” ratings will be interpreted as “satisfactory.”

PART III. PERFORMANCE ASSESSMENTS:

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

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

N/A U M S V E

1. Extent to which the company’s products and/or services met the specification/performance requirements:

2. Extent to which the Company met all requirements to deliver adequate technical manuals or commercial maintenance and operations manuals:

3. Your satisfaction with the Company’s “after the sale” service, e.g.

response to technical questions, warranty actions, reported deficiencies, product recalls, and other such actions:

4. Extent to which the Company had an adequate number of dedicated resources for your program:

5. Your satisfaction with the Company’s responsiveness to the customer needs involving unscheduled requirements or contract changes:

6. Extent to which the Company managed the program to ensure subcontractor work conformed to the technical requirements:

7. Extent to which the Company met the required production rate:

8. The quality of the completed product/service delivered by the Company:

9. The company performed independently its work on the contract or effort without significant customer direction/oversight:

10. Completed work on time:

FOR OFFICIAL USE ONLYPAGE 2 OF 4

PART IV. MISCELLANEOUS:

11. Has this company ever defaulted on any contact or portion thereof with your company? If yes, please explain the circumstances and the resolution.

(Provide additional sheets as required.) ________________________________________________________________________________________

12. Have there been any disputes or claims relative to the contract? If yes, please explain the circumstances and resolution. (Provide additional sheets as required.) _____________________________________________________________________________________________________________

13. What were the Company’s greatest strengths/weaknesses in the performance of the contract? __________________________________________

14. Given the opportunity to choose other suppliers or contractors, would you choose this Company again? If not, please explain. _________________

15. Please provide a statement describing your overall experience with the company being reviewed. (Feel free to add additional pages of attachments). Include any information you feel may be helpful in accurately evaluating this Company’s past and/or present performance. ___________________________________

16. Additional Remarks (Use additional pages if necessary):

Evaluator Signature Date

The Robins Air Force Team thanks you for your time.

RFP FA8519-12-R-00516

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

ASSESSMENT RATING SYSTEM

E EXCEPTIONAL (Blue): Performance meets contractual requirements and exceeds many requirements. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD (Purple): Performance meets contractual requirements and exceeds some requirements. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY (Green): Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL (Yellow): Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY (Red): Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE (White): Did not apply to this acquisition; or, questionnaire respondent has no knowledge of, and/or did not observe, the contractor’s performance in this area.

NOTICE TO QUESTIONNAIRE RESPONDENTS: Please do not transmit this page when faxing your input to the name/address listed on page 1.