20100210_NGW_Section_J_Attachment_J_PCA_Questionnaire.doc

ATTACHMENT J

PERFORMANCE CONFIDENCE ASSESSMENT QUESTIONNAIRE

When filled in this document is source selection sensitive information iaw FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION (to be completed by the offeror) A. Contractor: ______________________________________________________________________________

B. Cage Code of contractor contract was awarded to: _________________________________

C. Contract number: _______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs: _____________________________________ J. Description of service provided:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SECTION 2. CUSTOMER OR AGENCY IDENTIFICATION (to be completed by the offeror) 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:

SECTION 3. EVALUATOR IDENTIFICATION (to be completed by the evaluator) A. Evaluator's name: _________________________________________________________________________________

B. Evaluator's title: ______________________________________________________________________________________

C. Evaluator's phone/fax number: ___________________________________________________________________

D. Number of years evaluator worked on subject contract: _____________________

SECTION 4. EVALUATION (to be completed by the evaluator) Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE

PERFORMANCE LEVEL

B BLUE/EXCEPTIONAL - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

P PURPLE/VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

G GREEN/SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Y YELLOW/MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

R RED/UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

System Performance:

Operations and Maintenance:

Transition Plan

Management Approach

Small and Small Disadvantaged Business Participation

2. Please discuss each and every response for which you indicated B/E (Blue/Exceptional), P/VG (Purple/Very Good), Y/M (Yellow/Marginal) or R/U (Red/Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

3. Government Contracts Only: Has/was this contract been 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, etc).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs? To what extent would you recommend this contractor for additional contracts? Rate on the following scale:

5 = Yes, definitely; 4 = Yes, likely; 3 = Maybe, 2 = No, not likely; 1 = No, not ever; 0 = N/A.

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

Evaluator’s Signature: ______________________________

Date: ___________________________ Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

DISA/DITCO-Scott (PL8222), 2300 East Drive, Scott AFB, IL 62225-5406

Attn: MSC NGW Past Performance Team, E-Mail: lori.walker@disa.mil, or

Fax to (618) 229-9356/DSN 779

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Section J, Attachment J: Performance Confidence Assessment Questionnaire v 1.0