Attachment 8 Past Present Performance Questionnaire.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION – See FAR 2.101 and 3.104

Solicitation No.: FA4460-12-R-0006

Contract No.:

Attachment 8

MEMORANDUM FOR PROSPECTIVE OFFERORS

FROM: 19 CONS/LGCA

642 THOMAS AVENUE

LITTLE ROCK ARB AR 72099-4971

SUBJECT: Request for Past Performance Questionnaire Information for FA4460-12-R-0006, Airfield Pavements System IDIQ

1. Your have been identified as a reference point of contact for past and/or present performance evaluation of the firm listed on the attached questionnaire form. This firm is currently interested in providing a proposal for the above reference project.

2. Please complete the attached survey questionnaire. You should e-mail the survey back to

Rachel Italiano at rachel.italiano.1@us.af.mil. Also send a copy to Betty A. Rosewaren at betty.rosewaren@us.af.mil. You may fax the questionnaire to (501) 987-8119. If you have any questions, please contact Rachel Italiano at (501) 987-3847 or Betty A. Rosewaren at (501) 987-

8123. Your information MUST be submitted by 4 Sept 2012@ 2:00PM LOCAL (CST). Your expedient attention regarding this matter is greatly appreciated. Thank you in advance.

BETTY A. ROSEWARN

Contracting Officer

1. Atch

Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Telephone Number: ____________________

Address: __________________________ 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: ______________________*

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. FAX COMPLETED SURVEY FORM TO: _Rachel Italiano 501-987-8119_________

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (SUBC, SATC, LC, NC, and UC) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF LC or NC.

SUBC SATC LC NC UC

SUBSTANTIAL

CONFIDENCE

SATISFACTORY

CONFIDENCE

LIMITED

CONFIDENCE

NO

CONFIDENCE

UNKNOWN

CONFIDENCE

Based on the offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

No performance record is identifiable or the offeror’s performance record is so sparse that no confidence assessment rating can be reasonably assigned.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

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

The contractor: SUBC SATC LC NC UC

1. Followed all Airfield Regulations (i.e. speed limits, off limits areas etc.).

2.

Properly demonstrated the ability to communicate with the tower when needed (i.e.

operation of a land moblie radio, knows when the tower needs to be contacted etc.).

3. Demonstrated the ability to work on an airfield while the remaining area of the airfield is still operational.

4. Demonstrated ability to set up safe airfield construction zones and maintain safety controls throughout the project duration including moving to separate phases.

5. Demonstrated the ability to submit all required submittals throughout the duration of the contract.

6. Demonstrated the ability to set up and maintain Storm Water Pollution Prevention measures during construction.

7. Demonstrated the ability to submit accurate As-Built and/or GIS data, SDSFIE compliant, post construction.

8. Demonstrated ability to perform airfield rubber removal & friction testing on concrete & asphalt pavements by the chemical detergent method.

9. Demonstrated ability to complete demolition work on airfield concrete pavements without damaging surrounding concrete to remain.

10. Demonstrated the ability to complete partial depth airfield spall repairs on concrete.

11. Demonstrated the ability to complete full depth airfield concrete repairs.

The contractor: SUBC SATC LC NC UC

12. Demonstrated the ability to successfully place concrete in adverse conditions to include cold temperatures, hot temperatures and/or windy conditions.

13. Demonstrated cooperativeness to replace or correct failed areas of work such as cracked concrete.

14. Demonstrated the ability to finish airfield concrete.

15. Demonstrated ability to properly saw cut airfield concrete.

16. Demonstrated the ability to meet pavement smoothness and grade control requirements on new and repair construction projects.

17. Demonstrated the ability to meet subgrade and base course compaction requirements.

18. Demonstrated the ability to meet asphalt compaction, grade, and thickness

19. Demonstrated concrete quality control measures on all airfield concrete placements.

20. Demonstrated ability to install aircraft tiedowns and grounding rods in new and existing pavements.

21. Demonstrated ability to safely and technically install airfield electrical systems.

22. Demonstrated the ability to establish sod or hydro-seed post construction.

23. Demonstrated the ability to meet airfield drainage requirements by grading and piping.

24. Demonstrated the ability to layout and paint new airfield markings.

25. Demonstrated ability to eradicate airfield markings without damaging the pavement surface or joints.

26. Demonstrated ability to accurately keep installed quantities and submit for payment quantities on a line item contract.

27. Demonstrated flexibility and cooperativeness with scheduling work with respect to security requirements, airfield operations, military contingencies & exercises, DV visits, Air Shows, coordination with other ongoing airfield projects, and coordination with all project stakeholders.

28. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

29. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

30. Delegated authority to project managers and supervisors commensurate with contract requirements.

31. Home office participated in solving significant local problems.

32. Followed approved quality control plan.

33. Provided effective quality control and/or inspection procedures to meet contract

34. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

35. Provided timely resolution of contract discrepancies.

The contractor: SUBC SATC LC NC UC

36. Identified problems as they occurred.

37. Suggested alternative approaches to problems.

38. Displayed initiative to solve problems.

39. Developed realistic progress schedules.

40. Met established project schedules.

41. Provided timely resolution of warranty defects.

42. Was responsive to contract changes.

43. Provided adequate project supervision.

44. Obtained consent of surety for increases in bonding as work-in-progress increased.

45. Paid subcontractors/suppliers in a timely manner.

46. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

47. Cooperated with Government personnel after award.

48. How would you rate the contractor's overall performance?

49. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

Yes

No

50. Would you award another contract to this contractor? If not, explain in “remarks.” Yes No

51. Is the contractor rated in CPARS? Yes No

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

Remarks:______________________________________________________________________

Signature __________________________________________