Attachment_3_Past_Perf_Questionnaire-W91151-15-R-0028-Fort_Hood-3_August_2015.doc

ATTACHMENT 3

PAST PERFORMANCE QUESTIONNAIRE

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

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _______________________________________________________________________________

B. Cage Code: _________________________________

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

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

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

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

S 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.

M 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.

US

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

NA

NOT APPLICABLE - Unable to provide a score.

T1. Quality of operations

T2. Quality of technical system testing and certification efforts

T3. Quality/integrity of technical data/report preparation efforts

T4. Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

T5. Ability to implement current standard practices for computer hardware design, operation, maintenance, upgrades and configuration control

P1. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

P2. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

P3. Timeliness/effectiveness of contract problem resolution without extensive customer guidance

P4. Complied with customer objectives and technical requirements

P5. Successfully responded to emergency and/or surge situations

P6. Quality/effectiveness of sub-contracted efforts

P7. Effectiveness of material management (including Government Furnished Property or Material)

P8. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

P9. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

T1. Contractor ability to smoothly transition resources and personnel.

T2. Contractor effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

E1. Ability to hire/apply a qualified workforce to this effort.

E2. Ability to retain a qualified workforce on this effort.

C1. Accuracy in forecasting contract costs

C2. Ability to meet forecasted costs and perform within contract costs

C3. Ability to alert Government of unforeseen costs before they occur

C4. Sufficiency and timeliness of cost reporting

1. Please discuss each and every response for which you indicated M (Marginal) or US (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

2. 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?

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 via e-mail to:

david.a.higginbottom.civ@mail.mil

SAMPLE QUESTIONNAIRE COVER LETTER

LETTERHEAD

(Date)

FOR OFFICIAL USE ONLY

The Mission and Installation Contracting Command (MICC) - Fort Hood is in the process of selecting a contractor to provide Solid Waste Management for Fort Hood, Texas.

One of the considerations in proposal evaluation is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had firsthand experience with an offeror, for the evaluation of the offeror's performance on those contracts.

Our areas of interest in the offeror are summarized in the enclosed questionnaire. Please provide your written response no later than (NLT) 25 September. This schedule will allow us sufficient time to analyze the data prior to the start of evaluations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and "e-mailed" to mark.a.ramey10.civ@mail.mil . Please call Mr. Mark A. Ramey, Contract Specialist, at (254) 287-5574 prior to transmission if you have any questions. Your completed questionnaire will become a part of the official Source Selection records.

Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.