FTQW 23-5100 - Past Performance Questionnaire.pdf

Controlled Unclassified Information When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire – FTQW 23-5100

Controlled Unclassified Information Page 1 of 5

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. 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):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/02.htm#P10_602 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/03.htm#P41_5836

Past Performance Questionnaire – FTQW 23-5100

Controlled Unclassified Information Page 2 of 5

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Section 4: Performance Information

In the tables below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

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 – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

Past Performance Questionnaire – FTQW 23-5100

Controlled Unclassified Information Page 3 of 5

Technical Performance E V S M U N/A

T1. How well did the contractor meet the technical requirements of the specification?

SUPPORTING INFORMATION:

T2. How was the quality of any draft or intermediate submittals?

SUPPORTING INFORMATION:

T3. How was the quality/integrity of the final submittal(s), i.e., designs, studies, investigations, etc.?

SUPPORTING INFORMATION:

T4. If/When questions arose regarding the firm’s work or if errors or omissions were found, after payment of the final invoice, how willing was the firm to answer/correct/revise any work produced by them?

SUPPORTING INFORMATION:

T6. Were the staff/employees highly qualified and knowledgeable?

SUPPORTING INFORMATION:

T7. Was the firm cooperative and responsive to your needs and goals?

SUPPORTING INFORMATION:

Program Management E V S M U N/A

P1. How effective was overall contract management (including ability to effectively lead, manage, control and deliver on-time)?

SUPPORTING INFORMATION:

Past Performance Questionnaire – FTQW 23-5100

Controlled Unclassified Information Page 4 of 5

Program Management E V S M U N/A

P2. How reasonable and cooperative was the contractor when dealing with program staff (including the ability to successfully resolve disagreements/disputes)?

SUPPORTING INFORMATION:

P4. How well did the contractor understand/comply with project objectives and technical requirements?

SUPPORTING INFORMATION:

P6. How well did the contractor manage quality/effectiveness of subcontracted efforts?

SUPPORTING INFORMATION:

P9. Of what benefit to the customer were contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors?

SUPPORTING INFORMATION:

P10. To what degree did the contractor implement responsive/flexible processes to improve quality and timeliness of support?

SUPPORTING INFORMATION:

Cost Performance E V S M U N/A

C1. How accurately did the contractor forecast contract costs?

SUPPORTING INFORMATION:

C2. How well did the contractor meet forecasted costs and perform within contract costs?

SUPPORTING INFORMATION:

C3. How successfully did the contractor alert the Government of unforeseen costs before they occurred?

Past Performance Questionnaire – FTQW 23-5100

Controlled Unclassified Information Page 5 of 5

Cost Performance E V S M U N/A

SUPPORTING INFORMATION:

C4. How sufficient and timely was the contractor’s cost reporting?

SUPPORTING INFORMATION:

Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations?

☐ Yes ☐ Default ☐ Convenience ☐ Pending Terminations ☐ No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I [ click and select an item ] award to him today given that I had a choice.

REMARKS:

Please provide any additional comments concerning this contractor’s performance, as desired.

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-Mail to:

- Primary POC: Mrs. Kimberly Graham, kimberly.graham.3@us.af.mil

- Alternate POC: Mrs. Tara Richmond, tara.richmond@us.af.mil