Attachment_5_-_Past_Performance_Survey.doc

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PAST AND PRESENT PERFORMANCE QUESTIONNAIRE.

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IN

ACCORDANCE WITH FAR 3.104 AND 2.101

ATTACHMENT __

Note: Offeror complete pages 1-3 below. Reference shall complete pages 4-9.

1. Contractor (Name, Address, and Zip code):

2. Contract Number: ______________________________________________________________

3. Program/Project Title: __________________________________________________________

4. Type of Contract: Fixed Price ____ Cost Reimbursement ____ Other ____ (Explain)

5. Description, location, and relevancy of work (i.e., focusing on repair, replace, and installation of roofs)

6. Brief description of effort:

Prime ____ or Subcontractor ____

7. Complexity of Work: Difficult _______ Routine _______

8. Performance Period: ___________________________________________________________________

9. Date of Award: _______________________________________________________________________

10. Original Contract Dollar Value: _________________________________________________________

11. Current/Completed Contract Dollar Value: _______________________________________________

12. If amounts for 10 and 11 above are different, provide a brief explanation for the reason.

13. Contract Completion Date (including extension): __________________________________________

14. Type and Extent of Subcontracting: ______________________________________________________

15. Point of Contract Information:

a. Procuring Contracting Officer:

Name: ________________________________________________________________________

Address: ________________________________________________________________________

Fax: ________________________________________________________________________

Telephone Number: ______________________________________________________________

E-mail:

b. Administrative Contracting Officer (if applicable):

Address: ________________________________________________________________________

Fax: ________________________________________________________________________

Telephone Number: ______________________________________________________________

c. Contracting Officer’s Representative:

Address: _________________________________________________________________________

Fax: _________________________________________________________________________

Telephone Number: _______________________________________________________________

You have been provided as a reference in response to the solicitation (FA8751-13-R-0014) for Simplified Acquisition of Base Engineering Requirements (SABER) Indefinite-Delivery, Indefinite-Quantity contract at the Air Force Research Laboratory’s Rome Research Site, Rome, NY. In order for the government to evaluate the past performance of the firm providing you as a reference, please complete this questionnaire and forward to AFRL/RIKO in accordance with the instructions listed below.

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

Prior to completing the following questionnaire, please review pages 1-3 to ensure accuracy.

RESPONSE DATE: TBD

FAX TO (315) 330-2555, E-MAIL TO: CODY.OWENS @rl.af.mil

MAIL TO: AFRL/RIKO

ATTN: CODY OWENS

26 ELECTRONIC PARKWAY

ROME, NY 13441-4514

POC: CODY OWENS AT (315) 330-2921 OR DSN 587-2921

1. RESPONDENT/GOVERNMENT OFFICIAL’S INFORMATION

NAME: __________________________________________________________________

POSITION/TITLE: _________________________________________________________

ADDRESS: _______________________________________________________________

TELEPHONE NUMBER: _________________________FAX: _____________________

E-MAIL: _________________________________________________________________

2. RELATIONSHIP AND TIME INVOLVED WITH CONTRACTOR:

3. DATE QUESTIONNAIRE WAS COMPLETED: _________________________________

The following chart depicts the RATINGS that are to be used to evaluate the contractor’s performance:

Unsatisfactory/ No Confidence Marginal/

Little Confidence Neutral/

Unknown Confidence Satisfactory/

Confidence

High Confidence

For any neutral, marginal, or unsatisfactory rating, please provide explanatory narratives in the remarks block. These narratives needs not be lengthy, just detailed. If a question is not applicable, mark N/A. If more space is needed, use the back of the questionnaire or attach additional pages. If more space is needed, then go to page 10 to continue narration. Be sure to identify your continued narration with the respective line number.

CONTRACT WRITTEN BY: _____________________________________________

CONTRACT NUMBER: _________________________________________________

POINT OF CONTACT: __________________________________________________

NAME OF PRIME CONTRACTOR: _______________________________________

1. QUALITY CONTROL:

CIRCLE ONE

a. Provided Quality of Workmanship

1 2 3 4 5 6

b. Provided and Followed Effective

Quality Control (QC) Plan

c. Provided effective inspection procedures to Meet contract requirements

d. Stored materials properly

e. Used materials specified

f. Ordered and used adequate materials

g. Provided adequate submittals

h. Provided adequate as-built drawings

i. Identified/corrected deficient work in a timely manner

1 2 3 4 5 6

j. Suggested solutions and displayed initiative to implement solutions 1 2 3 4 5 6

ADDITIONAL COMMENTS: ________________________________________________________________

2. TIMELY COST EFFECTIVE PERFORMANCE

a. Provided submittals in a timely manner

b. Researched submittals well and

Clearly identified the proposed item

c. Matched submittals accurately to contract requirement

d. Met established allotted work schedule

e. Met established cost control; performed work within allotted budget

f. Resolved delays

g. Completed punchlist items timely

h. Completed punchlist items adequately

i. Completed work within performance period

j. Developed realistic progress schedules

ADDITIONAL COMMENTS: ________________________________________________________________

3. MANAGEMENT EFFECTIVENESS

a. General Business Practices:

1. Provided experienced managers and supervisors

1 2 3 4 5 6 with the technical and administrative abilities needed to meet contract requirements

2. a. Hired experienced subcontractors

b. Paid subcontractors/suppliers in a timely manner

1 2 3 4 5 6

3. Provided well substantiated pricing data for modifications 1 2 3 4 5 6

4. Completed all contract work prior to requesting

1 2 3 4 5 6 final inspection. Left no major discrepancies

5. Provided timely and satisfactory response to warranty issues after completion of project

6. Cooperated to resolve problems, attending meetings

1 2 3 4 5 6

(as applicable) and maintained communication to assure satisfactory resolution

7. Provide timely resolution of contract discrepancies

1 2 3 4 5 6

8. Obtained consent of surety for increases in bonding

1 2 3 4 5 6 as work in progress increased

b. Pricing

1. Submitted proposals that accurately represent the work required

2. Provided supporting price/cost information for modifications that were accurate, complete and reasonable

(not over inflated or under estimated)

3. The contractor’s overall pricing performance

c. Site Management/Superintendent

1. Site manager ensured compliance with contract requirements and safety

2. Site manager acted promptly to resolve problems

1 2 3 4 5 6 and ensure work quality

3. Delegated sufficient authority to Site Manager to

1 2 3 4 5 6 make decisions or take actions during project performance

4. Site manager consistently present on site when

1 2 3 4 5 6 work was performed

5. Contractor’s overall Management Effectiveness

1 2 3 4 5 6

ADDITIONAL COMMENTS: _________________________________________________________________

(4) COMPLIANCE WITH LABOR STANDARDS

a. Submitted payrolls in a timely manner

b. Completed payrolls correctly

c. Complied with labor laws and regulations with specific attention to the Davis-Bacon Act

ADDITIONAL COMMENTS: ________________________________________________________________

(5) COMPLIANCE WITH SAFETY STANDARDS

a. Provided adequate safety plan

b. Implemented safety plan

ADDITIONAL COMMENTS: ________________________________________________________________

Other Past Performance Considerations

1. Assessment of liquidated damages (frequency, circumstances, severity

(Yes No) of problem etc.)

2. Based on the contractor’s overall performance, would this contractor be re-hired? If not, explain in “Additional Comments”

3. Was the contractor cooperative in negotiating modifications so that they would result in fair and reasonable cost adjustments to the contract?

4. The contractor provided all deliverables (including documentation) in a timely and accurate manner.

5. Have there been any labor disputes or violations of public law?

6. Have there been any indicators that the contractor has had any financial difficulties?

7. Contractor submitted modifications and other required proposals in a timely manner.

8. Was the contractor ever issued a Cure or Show Cause Notice under the referenced contract? If yes, explain outcome in

“Additional Comments”

ADDITIONAL COMMENTS: ________________________________________________________________

THANK YOU FOR YOUR TIME AND QUICK RESPONSE.

SIMPLIFIED ACQUISITION OF BASE ENGINEERING REQUIREMENTS (SABER)

SOLICITATION FA8751-13-R-0014