11 Past Performance Questionnaire Template_Final.docx

DCSA BI Fieldwork CUI 11 Past Performance Questionnaire Defense Counterintelligence and Security Agency Background Investigation Fieldwork Services Solicitation HS002122R0002 / HS002122R0003

11 PAST PERFORMANCE QUESTIONNAIRE COVER LETTER AND FORM

<Letterhead>

The Defense Counterintelligence and Security Agency (DCSA) is soliciting proposals for Background Investigation Fieldwork Services.

One of the considerations in proposal evaluations is the verification of the Offeror’s past and present performance on contracts, which reflect the Offeror's ability to perform on the proposed effort. The Government depends 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 contract(s).

The areas of interest for the Government are summarized in the questionnaire below. Questionnaires should be completed and submitted by you directly to the DCSA contract specialist, Ms. Shelly Thieme, at shelly.l.thieme.civ@mail.mil no later than Friday, May 6, 2022 at 5:00 p.m.

Please complete Sections II and III of the attached questionnaire. Include your name and title, organization’s address, e-mail address, and telephone number. Use the rating scale and definitions found in the questionnaire to rate each performance element. Please sign the questionnaire.

The Government encourages comments. The last page may be used if additional space is needed for comments. Clear handwritten responses are sufficient.

Thank you for your time and participation.

Sincerely,

CUI // Source Selection Information. See FAR 2.101 and 3.104.

PAST PERFORMANCE QUESTIONNAIRE

SECTION I: CONTRACT IDENTIFICATION (To be filled out by Offeror)

1. CONTRACTOR’S NAME & ADDRESS:

2. CAGE CODE OF PRIME CONTRACTOR:

3. CONTRACT NUMBER (include task number if applicable):

4. AWARD ENVIRONMENT:

|_| COMPETITIVE |_| NON-COMPETITIVE

5. CONTRACT TYPE:

|_| FIRM FIXED PRICE |_| COST + FEE

|_| FIXED PRICE + FEE |_| LABOR HOUR

|_| COST or COST SHARING |_| TIME & MATERIALS

|_| OTHER ___________________

6. PERIOD OF PERFORMANCE (including options):

7. INTIAL CONTRACT VALUE (including options):

8. CURRENT/FINAL CONTRACT VALUE (including options):

9. REASONS FOR DIFFERENCES BETWEEN INITIAL CONTRACT VALUE AND FINAL CONTRACT VALUE:

10. DESCRIPTION OF PRODUCTS/SERVICE PROVIDED:

11. LOCATION SERVICES PROVIDED (local, nationwide, worldwide, etc.):

SECTION II. EVALUATOR AND AGENCY IDENTIFICATION (To be filled out by the Evaluator)

1. AGENCY (CUSTOMER) NAME:

2. EVALUATOR NAME & TITLE:

3. EVALUATOR CONTACT INFORMATION:

TEL NO.:

E-MAIL:

4. NUMBER OF YEARS EVALUATOR WORKED ON SUBJECT CONTRACT:

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

Adjectival ratings definitions to be used in your response:

EXCEPTIONAL (E) (Blue): During the contract period, contractor performance meets or met contractual requirements and exceeds or exceeded many to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VERY GOOD (VG) (Purple): During the contract period, contractor performance meets or met contractual requirements and exceeds or exceeded some to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective

SATISFACTORY(S) (Green): During the contract period, contractor performance meets or met contractual requirements. The contractual performance of the element or sub-element being assessed contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MARGINAL (M) (Yellow): During the contract period, contractor performance does not or did not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

UNSATISFACTORY (U) (Red): During the contract period, contractor performance does not or did not meet most contractual requirements and recovery in a timely manner is not likely. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

No Knowledge of This Element (NA): No knowledge of this element or does not apply to meeting contractual requirements

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

Comments:

Comments:

3. Contractor recruited, hired, and trained a qualified workforce with the appropriate skill levels to perform the required work.

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

Comments:

RATING

Comments:

Comments:

OVERALL RATING

|_| EXCEPTIONAL

(E) (Blue)

|_| VERY GOOD

(VG) (Purple)

|_| SATISFACTORY

(S) (Green)

|_| MARGINAL

(M) (Yellow)

|_| UNSATISFACTORY

(U) (Red)

Comments:

EVALUATOR’S SIGNATURE Date CUI // Source Selection Information. See FAR 2.101 and 3.104.