W911SD18R0145_ATTACHMENT__3_PAST_PERFORMANCE_QUESTIONNAIRE.docx

ATTACHMENT 3

W911SD-18-R-0145

REFUSE

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

1. Contractor: ____________________________________________________________________________

1. Cage Code: _________________________________

1. Contract number: _______________________________________

1. Contract type: ______________________________

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

1. Period of performance: _________________________________________________________

1. Initial contract cost: $____________________________

1. Current/final contract cost: $_______________________________

1. Reasons for differences between initial contract cost and final contract costs:

1. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

1. Customer or agency name: ____________________________________________________________________________________

1. Customer or agency description (if applicable): _____________________________________________________________________________________

1. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

1. Evaluator's name: ____________________________________________________________________________________

1. Evaluator's title: ____________________________________________________________________________________

1. Evaluator's phone/fax number: _____________________________________________________________________________________

1. 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 & repeatability of operations & maintenance.

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. Adequacy/effectiveness of environmental safety procedures

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. Understand/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. Effectiveness of acquisition management

P9. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

P10. 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.

E3. Effectiveness of employee compensation towards quality of work.

S1. Ability to meet or exceed small business and small disadvantaged business goals set forth in the approved subcontracting plan.

S2. Ability to effectively manage small business participation to meet technical performance.

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?

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

Please return this completed questionnaire to:

DAVID L. ARIOSTO

Contract Specialist MICC-West Point 681 Hardee Place 1st Floor Room 104

CCMI-CEU-WP

West Point, New York 10996-1514 Phone Commercial 845-938-8205

FAX 845-938-8183

EMAIL: david.l.ariosto.civ@mail.mil