PerformanceQuestionnaire.doc

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104

REQUEST FOR PROPOSAL FA8533-10-R-22041

ATTACHMENT 5

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature 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 Elizabeth.Midkif@robins.af.mil. Please Call (478) 222-1896 before transmitting by fax to ensure confidentiality.

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SOURCE SELECTION SENSITIVE INFORMATION 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:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104

PART II. GENERAL PROGRAM INFORMATION:

Period of Performance (assuming all options exercised) of Contract or Effort: Beginning Date _________ through ____________

Current Dollar Value (assuming all options exercised): ________________________________________________________________

PART III. PERFORMANCE ASSESSMENTS: NOTE: If respondent does not provide information to support any marginal, very good, or exceptional ratings that it may assign, the Government will interpret the rating as being a satisfactory one. Should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 3 of 4. Please check the appropriate rating for each of the following questions:

1. Extent to which Company’s products and/or services met the requirements of your contract or project:

2. Company’s proficiency with preparing technical data such as service bulletins, operations and maintenance manuals, or instructional videos:

3. Company’s history with timely deliveries of products/services and invoices:

4. Customer’s satisfaction with the company’s response to warranty claims, corrective actions, product recalls, and/or other “after the sale” actions:

5. Company’s knowledge and proficiency with industry specifications and standards, e.g. SAE, ASME, NEC, etc.

6. Quality of completed product:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104

7. Have there been any disputes/claims relative to the contract, or action of any kind to terminate performance? If yes, explain.

8. Describe the contractor’s strong and/or weak characteristics:

9. If given a choice, would your company award to this contractor again? If not, please explain. ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

10. Additional Remarks.

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104

RFP FA8533-10-R-22041

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

ASSESSMENT RATING SYSTEM

E EXCEPTIONAL: 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: 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: 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: 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: 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: 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.