C-5_Panel_Attach_3_-_Questionaire.docx

SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY

ATTACHMENT 3

01 Jun 2015

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. PQDRs: Quality problems were resolved adequately.

4. Data: Contractor had adequate ability to read and interrupt level 3 drawings.

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

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

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

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

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

10. Did the contract require a first article or pre-production sample? If yes, was it delivered timely and without quality problems?

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

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

16. Additional Remarks.

SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104

FOR OFFICIAL USE ONLY