PastPerformanceQuestionnaire13R0004UST WashRackFBGA.pdf

W911SF-13-R-0004

ATTACHMENT B

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.

The questions shown below should be tailored to the Factors/Subfactors of the instant acquisition.

Technical Performance S M US NA

T1. Quality & repeatability of wash rack 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. Ability to implement current standard practices for computer security and information security including personnel security clearances.

T6. Adequacy/effectiveness of safety procedures

T7. Adequacy/effectiveness of environmental safety procedures

T8. How well did the contractor perform to the size and scope of contract?

T9. How well did the contractor balance performing services at other locations utilizing unique skill sets at the complexity of the requirement?

Program Management S M US NA

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 and Government Furnished Equipment 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.

P11. How well did the contractor deal with unacceptable performance?

P12. Was the contractor effective providing the necessary manning at the appropriate skill mix to meet mission requirements?

Mobilization Plan S M US NA

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.

Employee Retention/Attraction S M US NA

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

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

E3. Ability to ensure qualified workforce maintains certifications required by the PWS, Federal, State and Local government.

Small and Small Disadvantaged Business Participation S M US NA

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.

Operation and Maintenance of Systems S M US NA

O1. Effectiveness performing maintenance on underground and above ground storage tanks

O2. Effectiveness performing leak testing on ground storage tanks

O3. Effectiveness of performing operational test for leak testing devices

O4. Effectiveness of overall contract management including ability to effectively perform environmental protection prevention and controls of pollution.

O5. Effectiveness of overall contract management including ability to effectively inspect, clean and perform maintenance of Vehicle Maintenance Facility Drain System.

O6. Effectiveness of overall contract management including ability to effectively operate, inspect, clean and perform maintenance of Wash Rack facilities

O7. Effectiveness of overall contract management including ability to effectively collect and dispose of used petroleum products

O8. Effectiveness of overall contract management including ability to effectively perform above and below grade waste oil tank collection.

O8. Effectiveness of overall contract management including the ability to perform general clean up operations/services

O9. Effectiveness of overall contract management including the ability to perform hazardous conditions containment and removal operations/services

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 to:

The Evaluator shall return completed questionnaire in hardcopy or by electronic mail to the below address/fax as soon as possible but no later than closing date of this solicitation

Mailing Address: 6650 Meloy Dr. Suite 250, Fort Benning, GA 31905

Or FAX/E-mail to: usarmy.benning.hqda-aca.mbx.doc-offer@mail.mil