Attachment 4 - Past Performance Questionaire Template.pdf
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- Solicitation number
- 12319826Q5007
About this file
This is a Past Performance Questionnaire template used by the Food and Nutrition Service (FNS), Contract Management Division, as part of a source selection evaluation for Solicitation Number 123198xxxx. The form is completed by references or past clients of a vendor being considered for contract award and submitted via email to LaShaun.Thompson@usda.gov.
The questionnaire requests evaluators to rate contractor performance across nine specific areas using a five-point rating scale: Exceptional (E), Highly Acceptable (HA), Acceptable (A), Marginal (M), and Unacceptable (U). The performance areas assessed include management and coordination of subcontractors and personnel, professional working relationships with Government personnel, ability to provide and retain qualified staff, quality control maintenance, schedule performance, problem rectification timeliness, and history of formal corrective actions such as cure notices, show cause letters, or payment suspensions. The form also requests an overall rating and allows space for additional comments. Evaluator information collected includes name, date, phone number, address, and position held in relation to the project. The document emphasizes source selection sensitivity and confidentiality, with FAR-mandated prohibitions against disclosing evaluator identities to maintain the integrity of the selection process.
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Text version
ATTACHMENT II
PAST PERFORMANCE QUESTIONNAIRE
SOLICITATION NUMBER:123198xxxx
THIS FORM IS PROVIDED FOR THE PURPOSE OF PROVIDING TO
AND SUBMITTAL BY THE VENDOR REFERENCES
Our company is being considered in a Source Selection by the Food and Nutrition Service (FNS), Contract Management Division. It would be appreciated if you would provide comments regarding our past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (FAR) prohibits the release of the names of individuals providing reference information about a Vendors past performance. In order to maintain the integrity of the source selection process, respectfully request that you do not divulge the name of the contractor nor discuss your comments on this questionnaire with any other individuals.
This form shall be sent via e-mailed to: LaShaun.Thompson@usda.gov
Past Project Information:
1. Contractor name and address:
2. Contract Number and Project Title:
Evaluator (The following information will assist in the analysis of the data. Information will be kept confidential.)
1. Name of Evaluator: Date:
2. Phone Number:
3. Address:
4. Position held or function in relation to the project:
RATINGS:
Please evaluate the contractor’s performance using the following ratings:
(E) Exceptional The contractor’s performance greatly exceeded the stated requirements.
(HA) Highly Acceptable The contractor’s performance exceeded the stated requirements.
(A) Acceptable The contractor’s performance met the stated requirements.
(M) Marginal The contractor’s performance met the stated requirements, but with difficulty.
(U) Unacceptable The contractor’s performance did not meet the stated requirements.
Please rate and provide any supporting information for the following: (Use additional sheets as necessary)
1. The contractor’s management and coordination of subcontractors/personnel assigned to the contract.
2. The contractor’s ability to maintain a professional working relationship with Government personnel.
3. The contractor’s ability to provide and retain qualified personnel to meet performance objectives as outlined in the Performance Work Statement or Statement of Work.
4. The contractor’s ability to maintain quality control.
5. The contractor’s ability to meet the performance schedule.
6. Was the contractor provided an opportunity to discuss any negative performance ratings? If so, what were the results?
7. The contractor’s ability to rectify identified problems in a timely fashion without further incident of the same.
8. Has the contractor been given any of the following: Cure notice; show cause, letters of reprimand, suspension of payments, termination? If yes, please explain.
9. Would you award another contract to this contractor? If no, please explain.
OVERALL RATING: _________________________
Please provide any additional comments:
| THIS FORM IS PROVIDED FOR THE PURPOSE OF PROVIDING TO |
| AND SUBMITTAL BY THE VENDOR REFERENCES |
| Our company is being considered in a Source Selection by the Food and Nutrition Service (FNS), Contract Management Division. It would be appreciated if you would provide comments regarding our past performance. Your comments are considered Source Sele... |
| This form shall be sent via e-mailed to: LaShaun.Thompson@usda.gov |
| Past Project Information: |
| 1. Contractor name and address: |
| 2. Contract Number and Project Title: |
| Evaluator (The following information will assist in the analysis of the data. Information will be kept confidential.) |
| 1. Name of Evaluator: Date: |
| 2. Phone Number: |
| 3. Address: |
| 4. Position held or function in relation to the project: |
| RATINGS: |
| Please evaluate the contractor’s performance using the following ratings: |
| (E) Exceptional The contractor’s performance greatly exceeded the stated requirements. |
| (HA) Highly Acceptable The contractor’s performance exceeded the stated requirements. |
| (A) Acceptable The contractor’s performance met the stated requirements. |
| (M) Marginal The contractor’s performance met the stated requirements, but with difficulty. |
| (U) Unacceptable The contractor’s performance did not meet the stated requirements. |
| Please rate and provide any supporting information for the following: (Use additional sheets as necessary) |
| OVERALL RATING: _________________________ |
| Please provide any additional comments: |
OVERALL RATING:
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