Amendment 001 - 11. Attachment 10. Past Performance Questionnaire_090821.docx

1332KP21RNEEB0003

SECTION J - ATTACHMENT 10

PAST PERFORMANCE QUESTIONNAIRE

Offeror/Contractor: Please complete Part 1 and provide each reference/evaluator with the form.

Reference/Evaluator: Please complete Part 2 and provide your candid responses. The information you provide will be used in the evaluation of the Offeror/Contractor for potential award of a federal contract or agreement; therefore, it is important that your information is factual, accurate, and complete as possible. You may annotate and provide the correct information accordingly in Part 1 if any information is incorrect.If you do not have knowledge of or experience with the company in question, please forward to the person who does.

Please submit the completed survey by email to Contracting Officer, Gion Lalican (gion.lalican@noaa.gov) and Contract Specialist, Samantha Dublin (samantha.dublin@noaa.gov) prior to 4:00 PM (ET) on September 29, 2021.

PART 1: (TO BE COMPLETED BY THE OFFEROR/CONTRACTOR)

A. NAME OF COMPANY BEING EVALUATED:

B. NAME/ADDRESS OF COMPANY PROVIDING EVALUATION INFORMATION:

Company Name:

Evaluator's Name and Title:

Address:

Telephone No.: E-mail Address:

C. PROJECT INFORMATION

(Under Work Description, include similarities/relevance to solicitation project AND a description of work performed to include specific requirements, location, and complexity.)

Contract No.:

Date of Award:

Project Title/Location:

Work Description:

Contract Type:

Original Contract Price:

Final Contract Price:

Original Completion Date:

Forecasted/Actual Completion Date:

Work was with: Commercial ____ Fed. Gov't ____ Local/City/State Gov't ____

PART 2: EVALUATION (INFORMATION TO BE COMPLETED BY THE REFERENCE/EVALUATOR RESPONDING FOR THE OFFEROR):

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor's control). An individual within your organization that is knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's (Offeror's) performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

Weaknesses or deficiencies were identified in their performance.

When responding to the questions listed, circle or highlight the letter that most accurately describes the contractor's performance or situation. For any Outstanding, Marginal or Unacceptable rating assessed by the customer on individual elements or overall rating assigned on the past performance questionnaire, shall include an explanatory narrative to be provided in the remarks block. These narratives need not be lengthy, just adequate to support evidence of the specific ratings noted above. Failure to provide information supporting the assigned rating may result in a lower rating being designated than that assigned by the Evaluator. If a question is not applicable, please indicate as such. If you circle a Yes or No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legible. Your time and effort in providing this information is vitally important and is greatly appreciated.

SUCCESSFUL PERFORMANCE OF CONTRACT REQUIREMENTS

1. Has an election ever been made not to exercise an option or continue relations due to the contractor’s poor performance?

2. Has a Contract Discrepancy Report ever been issued?

3. Has this contract been partially or completely terminated for default or convenience?

Partially _______ Completely _______

5. Would you contract with or hire this contractor again?

QUALITY AND TIMELINESS OF DELIVERY OF SERVICES

EFFECTIVE MANAGEMENT OF SUBCONTRACTORS

COST MANAGEMENT

1. Did the contractor successfully complete the project within budget?

LEVEL OF COMMUNICATION BETWEEN THE CONTRACTING PARTIES

PROACTIVE MANAGEMENT

CUSTOMER SATISFACTION

*NOTE: For any Outstanding, Marginal, or Unacceptable ratings assessed by the customer when completing this form, please include an explanatory narrative in the “remarks” block below.

*REMARKS

Are you aware of other relevant past efforts performed by this company? If yes, please provide the name and telephone number of a point of contact.

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