1305M326Q0035_Past_Performance_Questionnaire.pdf

SOLICITATION:

Past Performance Questionnaire INSTRUCTIONS: The Contractor shall complete blocks 1 – 4 on Page 1, then send entire document to the Client Reference for completion of the Past Performance Questionnaire. Completed Questionnaire shall be emailed to .

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: UEI Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

Prime Contractor Subcontractor Joint Venture Other

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Contract Agency:

Client Reference Name:

Client Reference Email Address:

Client Reference Phone Number:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

2. Work Performed as:

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

DESCRIPTION:

stephanie.mas Highlight

NOTE: THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL

INFORMATION ON THIS FORM.

RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE

CONTRACTOR’S PERFORMANCE OF THE SCOPE IDENTIFIED ON PAGE 1

RATING DEFINITION NOTE

(E) Exceeds Performance meets contractual requirements and exceeds aspects to the Government/Owner’s benefit. The contractual performance of the element was accomplished with no problems, and needed no corrective action throughout the term of the contract.

An “Exceeds” rating is appropriate when the Contractor performed all aspects of the scope of work without issue or need for corrective action.

There should be no weaknesses identified.

(S) Satisfactory Performance meets contractual requirements. The contractual performance of the element may have encountered minor problems for which corrective actions taken by the Contractor appear or were satisfactory.

A “Satisfactory” rating is appropriate when there were only minor problems, or major problems that the Contractor recovered from without impact to the contract. There should be no significant weaknesses identified.

(U) Unsatisfactory Performance does not meet contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

An “Unsatisfactory” rating is appropriate when significant events occurred that the Contractor had trouble overcoming, and which impacted the Government/Owner.

Significant weaknesses were identified.

(N) Not Applicable No information or did not apply to your contract.

Rating will be neither positive nor negative.

TO BE COMPLETED BY THE CLIENT REFERENCE

CLIENT REFERENCE INFORMATION

Name:

Title:

Phone Number:

Email Address:

Describe role as the Client in the project:

Date Questionnaire was completed (mm/dd/yy):

Client Reference’s Signature (digital acceptable):

PLEASE CIRCLE THE RATING THAT BEST REFLECTS YOUR EVALUATION

(AS THE CLIENT REFERENCE) OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY

a) Ability to meet quality standards specified for technical performance of the scope of work. E S U N

b) Effectiveness of contract problem resolution without extensive customer guidance. E S U N

2. SCHEDULE

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. E S U N

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract. E S U N

3. COST CONTROL

a) Ability to meet the terms and conditions within the contractually agreed price(s)? E S U N

b) Rate the contractor’s timeliness and accuracy in submitting invoice(s) with appropriate supporting documentation. (E.g., if monthly, did the contractor submit complete and accurate invoices each month on time)

E S U N

c) If this is/was a Government contract, has this contract been partially or completely terminated for default, cause, or convenience, or are there any pending terminations?

Yes No

4. MANAGEMENT

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? E S U N

b) Ability to hire, apply, and retain a qualified workforce for this effort. E S U N

c) Knowledge/expertise demonstrated by contractor personnel. E S U N

d) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes.

E S U N

5. REGULATORY COMPLIANCE

a) Compliance with contractual terms & conditions. (please explain below if specific issues) E S U N

b) Compliance with contract reporting requirements. (please explain below if specific issues) E S U N

6. OVERALL CUSTOMER SATISFACTION

a) Contractor was reasonable and cooperative in dealing with your staff (E.g., ability to successfully resolve disagreements or disputes, communication, etc.)

E S U N

b) Overall customer satisfaction. E S U N

c) Would you hire or work with this firm again? (if no, please explain below) Yes No

d) In summary, provide an overall rating for the work performed by this contractor. E S U N

Please provide additional explanation and/or remarks (if applicable).