Past Performance Questionnaire CIPS.pdf

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 38

TH

ENGINEERING INSTALLATION GROUP (AFMC)

TINKER AIR FORCE BASE, OKLAHOMA

DD MMM YY

MEMORANDUM FOR: ORGANIZATION

ATTN NAME

ADDRESS

CITY STATE ZIP

FROM: 38 CEG/PKE

4064Hilltop Road

Tinker AFB OK 73145-2713

SUBJECT: Past Performance Questionnaire for Request for Proposal FA8773-10-R-0088

1. The company (hereafter referred to as the “offeror” or “contractor”) listed below has responded to a Request for Proposal for the Cyberspace Infrastructure Planning System (CIPS). The scope of this work entails providing sustainment and maintenance of the system, to include continued modernization and growth of the system dependent on funding availability.

2. We are placing increased emphasis on our acquisitions on past performance as an evaluation factor. We have requested all offerors provide us with a list of references that can provide information about their past performance on similar contracts.

The offeror has identified you as the point of contact for the contract listed below. Your assessment of the offeror will be very helpful to us in our evaluation process:

Contractor: ADD SPECIFIC CONTRACTOR NAME HERE

Contract Number(s): ADD SPECIFIC CONTRACT # HERE

3. Please complete the enclosed survey and return it by close of business on DD MMM YY. The survey may be returned via:

E-mail: ADD SPECIFIC E-MAIL ADDRESS HERE

FAX: 405-734-XXXX or DSN 884-XXXX

Mail: See FROM line

4. Your assistance is greatly appreciated. If you have any questions, please contact the undersigned at 405-734-XXXX, DSN

884- XXXX.

//Signed//

CO

Contracting Officer

Attachment:

Past Performance Questionnaire

FOR OFFICIAL USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

1. Please complete this questionnaire. E-mail the completed questionnaire to the address as shown in the letter.

Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages.

Responses will be treated as source selection sensitive information.

2. PERFORMANCE CONFIDENCES DEFINED:

SUBSTANTIAL - Based on offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort.

SATISFACTORY CONFIDENCE – Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

LIMITED CONFIDENCE – Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort.

NO CONFIDENCE – Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

UNKNOWN CONFIDENCE – No performance record is identifiable or the offeror’s performance record is so limited that no confidence assessment rating can be reasonably assigned.

3. Please complete the following for the contract of which you are providing information and a past performance assessment:

A. Contractor:

B. Contract number:

C. Period of Performance:

D. Negotiated price or cost at award:

E. Current estimated contract dollar amount:

F. Describe product acquired:

4. For each item on the questionnaire, click on the words “select one” and a down arrow will appear. Click on the down arrow and select the appropriate performance confidence and provide supporting narrative for your response.

(1) Contractor’s cost control. Did the contractor deliver at the agreed-to price/cost? Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.)

______ SUBSTANTIAL CONFIDENCE

______ SATISFACTORY CONFIDENCE

______ LIMITED CONFIDENCE

______ NO CONFIDENCE

______ UNKNOWN CONFIDENCE

COMMENTS:

(2) Did the contractor deliver according to the agreed-to schedule? What were the causes of any schedule variances?

______ LIMITED CONFIDENCE

(3) How well did the contractor’s organizational support structure provide an adequate span of control and supervision?

______ LIMITED CONFIDENCE

(4) How well did the contractor team with his/her subcontractors?

______ LIMITED CONFIDENCE

(5) How would you rate the contractor’s on-site upper management personnel?

______ LIMITED CONFIDENCE

(6) How would you rate the contractor’s ability to maintain/retain skilled workforce?

______ LIMITED CONFIDENCE

(7) How well did the contractor manage an effective security program?

______ LIMITED CONFIDENCE

(8) How would you rate the contractor’s ability to promptly obtain security clearances for hired personnel?

______ LIMITED CONFIDENCE

(9) How would you rate the contractor’s utilization of appropriately skilled employees, equipment and materials to accomplish work requirements?

______ LIMITED CONFIDENCE

(10) How effective did the contractor use innovation and efficiencies to enhance contract performance and reduce cost?

______ LIMITED CONFIDENCE

(11) How well did the contractor identify inefficiencies that could adversely affect performance, and take corrective or preventive action to resolve problems?

______ LIMITED CONFIDENCE

(12) How well did the contractor meet emergency requirements?

______ LIMITED CONFIDENCE

(13) Has the Contractor ever been issued a contract discrepancy report (CDR)?

If yes, provide circumstance(s).

Yes __ No__

Circumstances(s):

(14) How would you rate the contractor’s workforce recruitment, training, qualification and certification programs during mobilization and transition?

______ LIMITED CONFIDENCE

(15) Did the contractor comply with contract terms and conditions?

______ LIMITED CONFIDENCE

(16) Did the contractor comply with the Service Contract Act and Davis-Bacon Act (i.e., were certified payrolls submitted timely)?

______ SUBSTANTIAL CONFIDENCE

______ SATISFACTORY CONFIDENCE

______ LIMITED CONFIDENCE

(17) How effectively did the contractor provide customer support?

______ LIMITED CONFIDENCE

(18) If record maintenance was part of the contract, were the records kept current and appropriate information properly entered?

______ LIMITED CONFIDENCE

(19) How well did contractor meet response times?

______ LIMITED CONFIDENCE

(20) How well did contractor meet required turn around times for maintenance efforts?

______ LIMITED CONFIDENCE

(21) Did the contractor provide timely and accurate deliveries of contract data reports (CDRLS)?

______ LIMITED CONFIDENCE

(22) Did the contractor have a safety program in place that complied with OSHA and all other applicable industry safety standards?

______ LIMITED CONFIDENCE

(23) How would you rate overall customer satisfaction with the contractor’s performance?

______ LIMITED CONFIDENCE

(24) Has the contractor ever been given a cure notice, a show cause notice, a suspension of payment, or had a claim denied? If yes, provide circumstance(s).

Yes __ No __ N/A __

Circumstances(s):

(25) Given the choice, would you award to this contractor again? If no, state why.

Yes __ No __

Supporting Narrative:

(26) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract?

Please identify contract/program and point of contact.

Yes __ No __

Contract/Program:

Point of Contact Name:

Point of Contact Phone Number:

Other information:

5. Please provide the name, title, address, and phone number of the person completing this questionnaire.

Name:

Title:

Address:

Phone Number:

FAX Number:

6. Thank you for your assistance in completing this questionnaire.