Att 05 - Past_Performance_Survey.pdf

ONCE COMPLETED, THIS DOCUMENT WILL BE CONSIDERED SOURCE SELECTION

SENSITIVE IN ACCORDANCE WITH FAR 3.104

Attachment 05:

Form L-2 Past Performance Survey 13 June 2011

RFP FA9301-11-R-0016

Attachment 05

SOLICITATION NUMBER FA9301-11-R-0016

PAST PERFORMANCE SURVEY

FOR

RFP NO. FA9301-11-R-0016

30 June 2011

The government is placing increased emphasis in its acquisitions on “past performance” as a source selection evaluation factor. You have been provided as a reference in response to the subject solicitation for HVAC Industrial Water Treatment Operation and Maintenance Service, Edwards AFB, CA.

In order for the government to evaluate the past performance of the firm providing you as a reference, please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this project. In accordance with FAR 15.306(e)(4), the name of individuals providing reference information about an offeror’s past performance shall not be disclosed.

Upon completion of this survey, please email to justin.vanorsdol@edwards.af.mil to the address shown below no later than 18 July 2011 at 4:00 PM.

AFFTC/PKOB

5 South Wolfe Ave.

Edwards AFB, CA 93524 Attn: Justin Van Orsdol Phone: (661) 277-2516

Bldg. 2800

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.

If you have any questions concerning this survey, please call undersigned at (661) 277-2516 or send e-mail to justin.vanorsdol@edwards.af.mil.

Your time and effort in providing this vitally important information are greatly appreciated.

JUSTIN VAN ORSDOL

Contract Specialist

AFFTC/PKOB

The below listed contractor has identified they provided or are currently providing services for your company/agency:

1. CONTRACT INFORMATION:

A. Contractor: ________________________________________________________

B. Contractor’s Address: _____________________________________________

C. Point of Contact: ___________________________________________________

D. Contract Number: ___________________________________________________

E. Period of Performance: _______________________________________________

F. Contract Type: Fixed Price _____ Cost Reimbursement _____

Other _______________________________________(specify)

G. Contract Amount: ___________________________________________________

H. Prime Contractor: YES NO

I. Services Provided (explain in detail the type of services provided by the contractor):

2. RESPONDENT INFORMATION:

Please provide the information requested below to assist the 18the CONS in tracking responses and resolving conflicts. You may be contacted for additional information pertaining to past or present performance of the contractor identified in section 1 above. This information will be kept confidential.

A. Name: ___________________________________________________________

B. Position and Title: __________________________________________________

C. Telephone Number: _______________________ FAX Number: _______________________

D. Address: ________________________________________________________

E. Relationship and Time Involved with Contractor: ________________________________________

F. Date Questionnaire was completed: ____________________________________

3. PERFORMANCE INFORMATION: The definition for the adjectival rating categories are provided below.

6 (E) 5 (VG) 4 (S) 3 (N) 2 (M) 1 (U)

Exceptional Very Good Satisfactory Neutral Marginal Unsatisfactory Performance met all contract requirements and exceeded many (approx.

20% of the entire contractual requirement).

Problems, if any, were negligible, and were resolved in a timely and highly effective manner.

Performance met all contract requirements and exceeded some (approx.

10% of the entire contractual requirement).

There were a few minor problems which the contractor resolved in a timely, effective manner.

Performance met contract requirements.

There were some minor problems, and corrective actions taken by the contractor were satisfactory.

No record of past performance, or the record is inconclusive.

Performance did not meet some contractual requirements.

There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance did not meet contractual requirements.

There were serious problems, and the contractor’s corrective actions were ineffective.

When responding to the questions listed, please choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. For any neutral (score of 3), marginal (score of 2), or unsatisfactory (score of 1) rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, circle N/A. If you circle a Yes/No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is needed, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly. If a statement is not applicable, indicate “N/A”

4. PAST PERFORMANCE QUESTIONNAIRE:

4.1 QUALITY OF SERVICE

a. Contractor’s ability to meet minimum quality standards specified for performance.

6 5 4 3 2 1 N/A

b. Contractor’s ability to effectively control the quality of services provided.

c. Contractor’s compliance with contractual terms and conditions.

4.2 TIMELINESS OF PERFORMANCE

a. Contractor’s ability to meet specific response times and scheduled time frames for completion of specific tasks.

b. Contractor’s responsiveness/timeliness for providing administrative reports/documents required by the contract.

c. Contractor’s timeliness in responding to emergency service requirements.

d. Provided timely resolution of contract discrepancies. 6 5 4 3 2 1 N/A

4.3 BUSINESS RELATIONS

a. Suggested alternative approaches to problems. 6 5 4 3 2 1 N/A

b. Displayed initiative to solve problems. 6 5 4 3 2 1 N/A

c. Contractor’s ability to identify problems and potential problems, and promptly notify the Contracting Officer/QAP.

d. Contractor’s ability to correct problems and prevent or mitigate potential problems in timely manner.

e. Contractor’s willingness to improve and correct noncompliance issues or concerns.

f. Contractor’s ability to use effective approaches and provide technical expertise and resources to solve contract problems.

g. Contractor’s flexibility in satisfying the requirements of its customers.

h. Extent to which the contractor provided prompt and courteous service when responding to customer complaints.

i. Ability to use effective approaches and provide technical expertise and resources to solve contract problems.

4.4 MANAGEMENT OF KEY PERSONNEL

a. Working relationship with the quality assurance personnel, and customers.

b. Extent key personnel were knowledgeable about contractual requirements.

6 5 4 3 2 1 N/A

c. Contractor’s ability to meet appropriate staffing levels with qualified personnel in order to provide required services.

4.5 COMPLIANCE WITH ENVIRONMENTAL, SAFETY, HEALTH, AND SECURITY

REQUIREMENTS

a. Has the contractor ever received any Notices of Violations for noncompliance with environmental laws or regulations?

b. Contractor’s compliance with safety requirements. 6 5 4 3 2 1 N/A

c. Contractor’s compliance with security requirements. 6 5 4 3 2 1 N/A

PLEASE INDICATE YOUR TOTAL SCORE OF THE

EACH BLOCK FOR THIS CONTRACTOR’S

ASSESSMENT HERE:

BASED ON ABOVE, WHAT IS YOUR OVERALL

ASSESSMENT OF THE PAST PERFORMANCE FOR

THIS CONTRACTOR?

E

VG

S

N

M

U

N/A

5. CONTRACTUAL CONSIDERATIONS

a. Has an election ever been made not to exercise an option or continue relations due to contractor’s poor performance? If yes, explain.

YES* NO

Remarks: ______________________________________________________________________

b. Has a Contract Discrepancy Report ever been issued? If yes, explain.

YES* NO

Remarks: ______________________________________________________________________

c. Was the contract partially or completely terminated for default or convenience? If yes, explain (e.g. inability to meet cost, performance, or delivery schedules).

YES* NO

Remarks: ______________________________________________________________________

6. CONCLUSTION:

Based on this contractor’s overall performance, would you hire this contractor again? If no, explain.

YES

NO*

Remarks: ______________________________________________________________________

The undersigned hereby confirms that the information provided in this document is correct as written.

Should any corrections be required, the undersigned shall contact the Contract Specialist at (661) 277- 2516 not later than 5 calendar days after receipt of this survey. This confirmation shall allow AFFTC/PKOB to use the information contained herein as source selection information.

Signature Date