Attachment_5_Past_Performance_Information_Form_FA9301_24_R_0001_Amended.pdf

Past and Present Performance Questionnaire

SUBJECT: Request for Past Performance Evaluation

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Integrated Solid Waste Services contract at Edwards AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at ________________________________.

Please submit completed questionnaire to the Government Contract Specialist identified on the attached questionnaire.

Contractor Signature

1 Attachment: Past and Present Performance Questionnaire

A. GENERAL INFORMATION:

Please correct any information below known to be inaccurate

Contractor’s Name: ____________________ Address:

Telephone Number: ____________________ Fax Number: ____________________ Point of Contact: ____________________

Project Title and Brief Description of Work*:

Contract Number Provided by Offeror: ________________ Dollar Amount: $__________

Contract Period or Dates of Performance Provided by Offeror*: _____________________

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ______________________ Address: ___________________________________________________________ Telephone Number: __________________________________________________ Fax Number: ________________________________________________________ Email Address: ______________________________________________________

C. SEND COMPLETED SURVEY FORM TO (E-mail is Preferred Method):

Thomas A. Prothro

AFTC/PZIOB

Thomas.prothro@us.af.mil

Stacey Stuart

AFTC/PZIOB

stacey.stuart@us.af.mil mailto:Thomas.prothro@us.af.mil mailto:stacey.stuart@us.af.mil

D. PERFORMANCE INFORMATION:

Choose the appropriate letter on the scale (E, G, S, M, U, N) that most accurately describes the contractor’s performance or situation or N/A if performance in this area is not applicable to the effort addressed.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective

Performance meets contractual requirements.

The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s corrective actions appear only marginally effective or were not fully implemented

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear to be or were ineffective

Performance was not observed or applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT #: _______________

Place an “X” in the appropriate column using the definitions matrix above.

Contractor Performance or Situation E G S M U N N/A

1. How well did the contractor implement an orderly transition from the incumbent contractor?

2. How well did the contractor comply with contractual terms and conditions including the preparation and timely/accurate submission of any required documents?

3. How well did the contractor attract and retain qualified and fully trained personnel at all levels within their organization to ensure contract compliance?

4. How well did the contractor manage personnel clearances in order to regularly service secured locations?

5. How well does the contractor’s organization provide the necessary manning, training, equipment, and supplies to meet contractual requirements?

6. How would you rate the contractor’s critical key management and technical staff in terms of expertise, knowledge and qualifications?

7. Rate contractor’s ability to respond to workload fluctuations, e.g.

budgetary fluctuations that resulted in increased or decreased activities.

8. How willing was the contractor to improve and correct noncompliance issues or concerns?

9.

10.

11.

12.

13.

14. Was the contractor ever issued a default, cure or show cause notice, Notice of

Violation under the referenced contract? If yes, explain outcome in “remarks.”

YES NO

15. Would you award another contract to this contractor? If not, explain in “remarks.”

YES NO

16. If a Government Contract, is the contractor rated in CPARS? YES NO

Remarks (provide detail regarding unfavorable ratings):