Attachment_5_-_Past_Performance_Questionnaire_-_Basewide_Elevator_Maintenance.pdf

FA8601-14-R-0020

Past Performance Questionnaire

Attachment 5

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104

I. INSTRUCTIONS TO RESPONDENTS: The Operational Contracting Branch at Wright-

Patterson Air Force Base (WPAFB), Ohio solicits your input regarding a contractor that has performed services for you in the past or is currently performing services for you. The following questionnaire will be used as part of the Government’s evaluation of the contractor’s proposal for

Basewide Elevator Maintenance and Repair Services. Completed questionnaires may be mailed, FedExed, faxed or emailed. Email is preferred. If the questionnaire is to be returned via email, convert the completed questionnaire to a PDF document and email it to jennifer.stephens.1@us.af.mil. NOTE: Questionnaires returned via e-mail must contain a subject line that reads “FA8601-14-R-0020, WPAFB Basewide Elevator Maintenance.” Email filters at

WPAFB are designed to filter emails 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 PDF format, the e-mail may not get through the email filters.

The mailing address is:

AFLCM/PZIOBA

ATTN: Jennifer Stephens (Ref: FA8601-14-R-0020)

1940 Allbrook Drive, Room 109

Wright-Patterson AFB OH 45433-5309

The fax number is 937-656-1412 (must have "ATTN: Jennifer Stephens).

Whether you choose to email, mail, fax, or submit completed questionnaires by other means, they must arrive not later than 12:00 P.M. local time, 15 October 2014.

Return surveys directly to the point-of-contact identified above. Do not route completed surveys through the contractor that performed services for your organization. Surveys received directly from contractors will not be used in the evaluation.

Your responses should be based on your own knowledge of the contractor’s performance, which may be supplemented by input from others in your organization with knowledge of the contractor’s performance. If you need more space than is provided, please attach a separate sheet to the end of this questionnaire.

Complete a separate questionnaire for each contract the contractor performed for your organization.

II. RESPONDENT INFORMATION:

mailto:jennifer.stephens.1@us.af.mil

a. Name of Respondent/Evaluator: ___________________________________________

b. Name and Address of Respondent’s Organization:

c. Organizational Telephone No.: ________________________________________

d. Fax Number: ______________________________________________________

e. Email Address: ___________________________________________________

f. How long were you involved with the contract being evaluated?

III. GENERAL INFORMATION ON CONTRACTOR BEING EVALUATED

a. Name of the Firm:

b. Contract Number or Other Reference Number: ______________________________

c. Description of Services Provided:

Did the contract involve providing the following services or performance of the following tasks?

Circle the appropriate response.

Performing scheduled services on elevators YES NO

Routine repairs of elevators YES NO

Unexpected or emergency repairs of elevators YES NO

Performing routine maintenance on elevators YES NO

e. How elevators were included in the contract?

f. What types of elevators were included in the contract (hydraulic, dumbwaiter, etc)?

g. Period of Performance: (How long did the contractor perform services for you? What was the start and ending dates of the contract?)

h. US GOVERNMENT CONTRACTS ONLY: Was the contract terminated prior to the agreed upon period of performance? ( ) Yes ( ) No

If yes, explain.

i. Contract Type: (Firm Fixed-Price, Cost Reimbursement, Award Fee, etc. What was the basis for the contractor’s compensation?)

j. Contract Value for the Performance Period Sated in U.S. Dollars: _________________

k. Did this company use any subcontractor(s) to accomplish the required work?

( )Yes ( )No

l. If subcontractors were used, what was the approximate percentage of the work subcontractor(s) performed? ____%

m. Were there any claims or litigation? ( ) Yes ( ) No

If yes, please elaborate.

IV. EVALUATION

Please use the definitions below to rate performance of aspects 1 through 5 below. Circle the appropriate rating.

Rating Description

Acceptable

(A)

During. During the entire performance period, the contractor met the requirements of the contract and consistently performed at an acceptable level. Performance may have been accomplished with some problems, but the contractor took effective corrective action for those problems that did occur.

Unacceptable

(U)

During most of the performance period, the contractor did not meet the requirements of the contract and performance was consistently at an unacceptable level. There were a number of serious problems that required extensive oversight and involvement, and corrective actions were either ineffective or non-existent.

Not Applicable

(N/A)

Unable to provide a rating. Contract did not include performance for this aspect or information is not available to rate this aspect.

Do not know.

1. Technical:

a. Quality Control Plan A U N/A

b. Admin Support A U N/A

c. Maintenance Control Plan A U N/A

2. Routine Repairs A U N/A

3. Emergency Repairs A U N/A

4. Repair Call Response Time A U N/A

5. Reporting Procedures A U N/A

Please explain if you circled U for any aspect above.

Overall Customer Satisfaction:

1. On the scale below, circle the number that indicates your organization’s overall satisfaction with the contractor’s performance.

1 – Very dissatisfied

2 – Dissatisfied

3 – Unsure

4 – Satisfied

5 – Very satisfied

Please explain if you circled numbers 1 or 2 above.

2. In a competitive situation, all other factors being equal, would you award this contractor another contract based on their past performance? ( ) Yes ( ) No

Please explain if you answered no above.

Additional Comments: Please feel free to provide any further information not covered in this questionnaire as an attachment that you feel would help us in evaluating the contractor’s past performance.

TYPED/PRINTED NAME DATE

POSITION TITLE

SIGNATURE

Please accept our sincere appreciation for taking the time to complete this questionnaire.

Your participation will be of great value to us.