PAST PERFORMANCE QUESTIONNAIRE 12.12.11.pdf

FOR OFFICIAL USE ONLY (WHEN FILLED IN IAW FAR 3.104-3)

FA8601-12-R-0010

UPS/PDU Maintenance

PAST PERFORMANCE QUESTIONNAIRE

FOR

UNINTERRUPTIBLE POWER SUPPLY (UPS) AND POWER DISTRIBUTION UNIT

(PDU) MAINTENANCE

17 Nov 2011

Wright-Patterson Air Force Base (WPAFB), Ohio seeks your input regarding the past performance of a previous supplier UPS/PDU Maintenance. The following questionnaire will be used as part of the Government’s evaluation of the offeror’s proposal for UPS/PDU Maintenance to be provided on WPAFB. Please complete, sign and return the questionnaire directly to the Government. Questionnaires can be returned via email (Sara.Blue@wpafb.af.mil), fax (937-656-1412). Only questionnaires received directly from respondents will be used in the evaluation. Signed and completed questionnaires must arrive not later than 12:00 PM on 3 Jan 2012. Any questions should be directed to Lt Ashley Cunningham at Ashley.cunningham@wpafb.af.mil or (937) 522-4520.

a. E-mail signed and completed questionnaires as a file attachment in the Adobe Acrobat format (*.pdf). NOTE: Questionnaires returned via e-mail must contain a subject line that reads “FA8601-12-R-0010, Past Performance Questionnaire.” E-mail filters at Wright-Patterson Air Force Base are designed to filter e-mails without subject lines or with suspicious subject lines or contents (i.e., .exe or .zip files).

Therefore, if the prescribed subject line is not included or the attachment is not in the Adobe Acrobat .pdf format, the e-mail may not get through the e-mail filters.

b. Fax signed and completed questionnaires to the attention of Sara Blue, at (937) 656-

1412. Please send an email alerting me that the information has been faxed.

c. Our areas of interest are summarized in the enclosed questionnaire. You are urged to submit your comments on similar programs/projects for which you had/have contracts or administer contracts with the offeror. Any additional information that you think would benefit WPAFB in our evaluation of the offeror’s proposal would be appreciated. Please note we may contact the offeror on problem areas or concerns identified to see what corrective actions have been taken or will be taken. The names of personnel responding to this questionnaire will not be provided to the offeror.

d. Thank you for your time and effort in helping us with this requirement.

PAST PERFORMANCE QUESTIONNAIRE

FOR

UPS/PDU Maintenance and Repair Services

1. Contractor Being Evaluated:

a. Contractor’s Name: _________________________________________________

b. Contract Number: __________________________________________________

c. Program Title: _____________________________________________________

d. Period of Performance: ______________________________________________

e. Total Dollar Value: __________________________________________________

f. Is the contract fixed price? _____ Yes _____ No (If no, what type? __________)

2. Description of Services Provided:

a. Contract/job size (Large/Medium): __________________________

b. Was this contractor the Prime Contractor or a Subcontractor? (Please circle)

c. Was equipment serviced a Liebert and Powerware system? ____ Yes _____ No

d. Did this contractor perform Preventive Maintenance Service? _____Yes _____No

e. Did this contractor perform Emergency Maintenance Service? _____ Yes

______ No

f. Was this contractor selected on a competitive basis? _____ Yes _____ No

Remarks: __________________________________________________________

g. Number of locations serviced by this contract: ____________________________

3. Please respond to the following questions regarding the contractor’s past performance.

Circle the word that represents your agreement or disagreement with statements regarding the contractor’s performance. Please provide additional comments for each question to help us fully understand your response.

Exceptional/High Confidence Offeror’s performance in the area of evaluation clearly exceeds requirements.

Essentially no doubt that offeror will successfully perform the required effort.

Very Good/Significant Confidence Offeror’s performance in the area of evaluation met/meets all requirements and exceeded/exceeds some requirements in some areas. A few minor problems existed/exist but were/are managed effectively. Little doubt exists that the offeror will successfully perform the required effort.

Satisfactory/Confidence Offeror’s performance in the area of evaluation met/meets requirements.

Problems existed/exist but were/are managed effectively. Some doubt exists that the offeror will successfully perform the required effort.

Marginal/Little Confidence Offeror’s performance met/meets most, but not all, requirements. Problems existed/exist in significant area(s) and management attention was/is needed.

Substantial doubt exists that the offeror will successfully perform the required effort.

Unsatisfactory/No Confidence Offeror’s performance did/does not meet requirements. There were/are multiple problem areas. Offeror was/is generally ineffective. Extreme doubt exists that the offeror will successfully perform the required effort.

Not Applicable/Unknown Confidence Does not apply to offeror’s performance or have no knowledge of the offeror’s performance within the area of evaluation.

MANAGEMENT/PERSONNEL/STAFFING:

a. Were you satisfied with the company’s management of the contract? Please explain if dissatisfied.

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A Narrative: _______________________________________________________________

b. Was the contractor effective in interfacing with the government’s/industry staff?

Were workers courteous?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

c. Did the contractor provide adequate numbers of qualified service technicians to complete the contract/job or repairs?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

d. Did the contractor provide preventative maintenance? If so, within what time frame was it provided?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

e. Was the contractor able to support emergency repair? If so, within what time frame was it provided?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

QUALITY OF SERVICE:

a. Did the contractor comply with the specific contract performance standards for each task, and implement their own quality control?

_____ Yes _____ No (Please Explain)

b. Were required proposals, reports/documentation submitted in a timely manner, complete and accurate?

_____Yes _____ No (Please Explain)

TERMINATION HISTORY:

a. Has this contract been partially or completely terminated for default or convenience?

_____Yes _____ No (Please Explain on the next page)

b. Are there any pending terminations?

_____Yes _____ No (Please Explain)

COST MANAGEMENT:

a. Did the contractor meet the proposed cost estimates? (Please mark best applicable with an X or checkmark.)

Less than estimated cost ( ) Comparatively equal to estimates ( ) Exceeded cost estimates ( ) Considerably surpassed estimates ( )

Comments: ____________________________________________________________________

GENERAL:

a. Based on your judgment of the contractor’s performance, would you award the contractor another contract?

_____Yes _____ No (Please Explain) Narrative: _______________________________________________________________

b. Overall, how satisfied were/are you with the work accomplished by this company?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Neutral Narrative: _______________________________________________________________

4. The following information will help us track the responses received, as well as resolve whatever differences may arise between your perception of the contractor’s performance and the contractor’s perception of their performance. You are advised that the offeror will be given an opportunity to respond to adverse past performance information. Names of personnel responding to this questionnaire will not be provided to the offeror.

a. Evaluator’s Name: __________________________________________________

b. Title: _____________________________________________________________

c. Telephone Number: DSN: Commercial: __________________________________

d. Organization, Office Symbol, and Address: _______________________________

e. Length of Involvement in the Contract: __________________________________

f. Date of Questionnaire Completion: _____________________________________

5. Thank you for your time and effort in assisting us with our requirement. Please use the space below for any additional information that would be helpful to the Government in evaluating the past performance of this offeror.