02.02.01 Proposal Attachment 2 - Past Performance Questionnaire.DOCX
DOCX document 25 KB Posted
- Attached to
- 70FBR426Q00000010 | DR4899-MS RFQ - Level II Armed Guard Services Federal contract opportunity
- Solicitation number
- 70FBR426Q00000010
- Issued by
- Federal Emergency Management Agency
About this file
This is a Past Performance Questionnaire template designed for reference checks on contractors competing for federal contracts under FEMA solicitations. The form requests detailed evaluations from previous customers or agencies that have worked with a contractor, assessing performance across three primary rating categories: Quality of Service, Timeliness of Delivery, and Overall Customer Satisfaction. Each category uses a five-point scale (Unsatisfactory, Poor, Fair, Good, Excellent) with specific performance criteria provided as guidance for evaluators. The Quality of Service rating addresses compliance with contract requirements, technical excellence, and budget performance. Timeliness of Delivery focuses on achievement of interim milestones and adherence to schedules. Overall Customer Satisfaction evaluates effective management, responsiveness, and problem notification.
The questionnaire collects administrative information including the contractor's name and address, solicitation/contract number, contract type (Firm Fixed Price, Cost Reimbursement, or Other), period of performance, overall contract value, and contract title. Reference providers must identify themselves with name, title, organization, phone number, and fax number. The form includes space for detailed comments justifying ratings and asks whether the reference would select the contractor again. Completed questionnaires are directed to be submitted to Meeka Tilahun, FEMA Contracting Officer, with contact information provided. This template is used in conjunction with RFQ 70FBR426Q00000010 for Level II Armed Guard Services in Mississippi for disaster recovery operations DR4899-MS.
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Text version
Section J Attachment # Page 1of 2
Contract Performance Customer Questionnaire
1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information and will be sent directly to the Contract Specialist. This information is not to be released to the offeror. Completed questionnaires may be emailed to:
ATTN: Meeka Tilahun, Contracting Officer DHS/Federal Emergency Management Agency Phone: (202) 735-7274| Email: fmeeka.tilahun@fema.dhs.gov
2. Please complete:
Company/Contractor Requesting Reference
Agency/Company Name Providing Reference
Company/Contractor Name
Agency/Company Name
Point of Contact Name
Point of Contact Name
Phone #
POC E-mail / Phone #
E-mail address
Period of Performance
Fax Number
Supply/Service Provided
PAST PERFORMANCE RATING GUIDELINES
Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Poor, Fair, Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”
N/A - NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.
| Ratings |
| Quality of Service |
-Compliance w/contract requirements -Technical excellence -Within budget -Relationship of negotiated costs to actual Timeliness of Delivery -Met interim milestones -Reliable -Delivery Schedule achieved Overall Customer Satisfaction -Effective Management -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable/cooperative -Flexible -Pro-active
| Unsatisfactory |
| Nonconformances |
are comprising the achievement of contract requirements
| Delays are compromising achievement of contract requirements |
| Response is not effective |
| Poor |
| Nonconformances |
require major agency resources to ensure achievement of contract requirements
| Delays require major agency resources to ensure achievement of contract requirements |
| Response is marginally effective |
| Fair |
| Nonconformances require minor agency resources to ensure achievement of contract requirements |
| Delays require minor agency resources to ensure achievement of contract requirements |
| Response is somewhat effective |
| Good |
| Nonconformances |
do not impact achievement of contract requirements
| Delays do not impact achievement of contract requirements |
| Response is usually effective |
| Excellent |
| There are no quality problems |
| There are no delays |
| Response is effective |
PAST PERFORMANCE QUESTIONNAIRE
| 1. Company/Contractor Being Referenced: |
| 2. Solicitation/Contract Number: |
| 3. Address: | |
| 4. Contract Type: | |
| |_| | Firm Fixed Price |
| |_| | Cost Reimbursement |
| |_| | Other (Please Specify) |
| 5. Agency/Company Completing Reference: |
| 6. Agency/Company POC, Phone & Fax: |
7. Period of Performance:
8. Overall Contract Value: $
9. Title of Contract:
10. Description of Contract Service:
11. Complexity of Work: Difficult: |_| Routine: |_|
NOTE: Please use adjectival ratings from attached sheet.
| 12. Evaluation Factor |
| 13. Rating |
| 13. Comments (Attach additional sheets, if necessary.) |
a. Quality of Service
b. Timeliness of Delivery
c. Overall Customer Satisfaction
15. Would you select this company/contractor again? Please explain. (Attach additional sheet if necessary.)
16. Name & Date:
17. Title:
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