AT5_PastPerformanceQuestionnaire21May.doc

(WHEN COMPLETED) SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104. FOR OFFICIAL USE ONLY

ATTACHMENT 5 (Dec 2009)

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

RFP Number

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program Manager):________________________________________________________

Agency or Business: ______________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Address: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________

Telephone No. _______________________________

FAX No. ____________________________________

Return your completed questionnaire either electronically, by fax or by mail.

If emailing, email to: Benjamin.Wilton@Robins.AF.MIL If mailing, mail directly to:

580 ACSG/GFKA

235 Byron Street, Suite 19A

Robins AFB, GA 31098-1670

ATTN:

Benjamin Wilton or Beckie King

If mailing, the outside envelope must be marked as follows:

NOTE: TO BE OPENED BY ADDRESSEE ONLY

SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY

If faxing, the fax number is 479-926-3306. The POCs must call Benjamin Wilton, 478-926-2478 before faxing the completed questionnaire(s).

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE RELEASED TO THE OFFEROR.

Part I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________

CAGE Code: __________

Program Title and Brief Description: _____________________________________________________________________________________

Role in the Program/Work Performed As:

_____Prime _____Subcontractor _____Vendor/Supplier

Contract Number: ________________________________ Number of Years?: Basic:________ Option: _________

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, etc._________________________________________________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

Period of Performance:

1. Original Schedule (assuming all options exercised): Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised): Beginning Date _________ through ____________

3. Reason for difference (if applicable) ___________________________________________________________________________________

Contract Dollar Value:

1. Original MAX Contract $ Value (assuming all options exercised):________________________________________________________

2. Current MAX $ Value (assuming all options exercised): ________________________________________________________________

3. Primary Causes of Changes: ______________________________________________________________________________________

NOTE: In Part III., should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 4 of 5.

PART III. PERFORMANCE ASSESSMENTS.

Please check the appropriate rating for each of the following questions:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

1. Extent to which Company’s products and/or services met the specification /performance requirements:

2. Configuration Management (first product delivered same as last):

3. Quality of Completed Product:

4. Overall management of subcontracting efforts:

5. Quality of technical manuals or commercial manuals/drawing package:

6. Quality of contractor installation:

7. Adequate Number of Dedicated Resources For Your Program:

8. Timely recognition and notification of administrative, engineering, production, problems affecting the program:

9. Company performed independently without significant customer direction/oversight?

10. Monitoring of Program Schedules and Critical Milestones:

11. Quality of stress analysis/report:

12. Company demonstrated positive responsiveness to unscheduled requirements or contract changes:

13. Has action been initiated to cancel or terminate the contract for default? If yes, explain. ________________________________________________________________________________________________________________________

14. Have there been any disputes/claims relative to the contract? If yes, explain.

15. Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract. ________________________________________________________________________________________________________________________

16. If given a choice, would you award to this contractor again? If not, please explain. ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

17. Do you feel you “got what you paid for” ? Please explain. ____________________________________________________________________________

18. Additional Remarks.

RFP FA8509-10-R-21507

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

ASSESSMENT RATING SYSTEM

E EXCEPTIONAL: Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD: Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY: Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL: Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE: Did not apply to this acquisition; or, questionnaire respondent has no knowledge of, and/or did not observe, the contractor’s performance in this area.

NOTICE TO QUESTIONNAIRE RESPONDENTS: Please do not include this page when returning the completed questionnaire.

(WHEN COMPLETED) SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104. FOR OFFICIAL USE ONLY