ASCPV Attach 3 - Questionaire.docx

SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY

ATTACHMENT 3

13 Dec 2010

Present/Past Performance Questionnaire (TO BE COMPLETED BY Relevant POC)

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. ____________________________________

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: _______________________________________________________________________________________________________________________________________________________________________________________________________

Contractor’s Role in the Program: _____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 indicate the appropriate rating for each of the following questions in table below:

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.

1. On-Time Delivery: Were the items on the contract delivered in accordance with the terms of the contract?

2. Quality: Did the items delivered conform to the specifications of the contract?

3. Overall management of subcontracting efforts: Did you have any complaints from the subcontractors, e.g. regarding payments, item acceptance, surveillance, schedule impacts, etc.?

4. Level of business electronic data exchange supported by the contractor was adequate for contract reporting, pricing, payment, tracking for analysis purposes:

5. Responsiveness to changes in the contract:

6. Timely recognition and notification of obsolescence and diminishing manufacturer issues:

7. Company performed independently without significant customer direction/oversight:

8. Adequate Personnel Resources For Program Implementation:

9. Extent to which Company’s services met the specification /performance requirements:

10. Post-award requests for technical information was adequate:

11. Developed and qualified new sources of supply:

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

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

13. 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. ___________________________________________________________________________________________________________________________ ________

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

15. Do you feel you “got what you paid for”? Please explain. ____________________________________________________________________________________________

1. Was your cost growth over the life of the contract within reason? Please explain.

17. Additional Remarks.

SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY