12319826R50001 Past Performance Questionaire for Retailer Investigations.docx
DOCX document 32 KB Posted
- Attached to
- 12319826R5000 Retailer Investigations
- Solicitation number
- 12319826R5000
About this file
This is a Past Performance Questionnaire template for vendor references related to solicitation 12319826R5000 for Retailer Investigations support services. The questionnaire is issued by the United States Department of Agriculture (USDA), Food and Nutrition Service (FNS), Contract Management Division, to be completed by references familiar with a contractor's prior performance on relevant projects. Completed forms should be submitted via email to Ian Lipscomb at Ian.Lipscomb@usda.gov.
The questionnaire requests evaluator information and requires rating of contractor performance across nine evaluation criteria using a five-point scale: Exceptional (E), Highly Acceptable (HA), Acceptable (A), Marginal (M), and Unacceptable (U). Performance areas assessed include management and coordination of subcontractors and personnel, professional working relationships with government personnel, ability to provide and retain qualified personnel, quality control maintenance, adherence to performance schedules, problem rectification capability, and past corrective actions or disciplinary measures. Evaluators must also provide an overall rating and indicate willingness to award future contracts. The questionnaire emphasizes that reference information is source selection sensitive and evaluator names will be kept confidential per Federal Acquisition Regulation requirements.
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Text version
ATTACHMENT II
PAST PERFORMANCE QUESTIONNAIRE
SOLICITATION NUMBER:12319826R5000
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: to Ian Lipscomb at Ian.Lipscomb@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:
File details come from the government source that posted it. Updated .