Attachment - Past Performance Questionaire.docx

Past Performance Questionnaire

PART I: FOR COMPLETION BY OFFEROR.

Instructions:

Offerors are required to complete all items set forth in this Part I for each reference and return the completed forms with the proposal.

Offerors are also required to coordinate with their identified references, supplying them with the completed Part I and blank Part II for completion, sufficiently in advance of the due date identified in Part II.

Name and address of individual/firm being evaluated:

Name of firm/agency for which the referenced work was performed:

Address of firm/agency:

Name, title, employer, and contact information for individual providing reference:

Contract number:

Period of performance:

Contract award date:

Contract amount:

Description of the contract work:

Relevance of the referenced contract to the current requirement:

PART II: FOR COMPLETION BY REFERENCE.

Instructions:

References are asked to complete all items set forth in this Part II and return the completed form no later than

Responses can be sent by any one of the following methods:

Fax:

E-mail:

Mail:

Background Information

Name of respondent:

Position and title:

Employer name:

Employer’s address:

Basis of qualification to evaluate contractor’s performance:

Contract number:

Contract award date:

Contract completion date:

Contract amount:

Names of key contractor personnel:

Description of the contract work:

Evaluation

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 of 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 who 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 performance with the judgment of others within their organization, as applicable.

Date this questionnaire completed:

Please provide answers to the questions listed below. When responding to the questions listed, circle the letter that most accurately describes the contractor’s performance or situation (see the “ratings” chart below for a description of each letter). For any neutral, marginal, or unsatisfactory rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, circle N/A. If you circle a Yes/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 legibly.

Ratings

PERFORMANCE ELEMENTS:

A. QUALITY OF PRODUCT OR SERVICE

Rating

B. TIMELINESS OF PERFORMANCE (SCHEDULE)

Rating

C. BUSINESS RELATIONS/CUSTOMER SATISFACTION

Rating

D. COST MANAGEMENT

(NOT APPLICABLE TO FIXED-PRICE CONTRACTS)

Rating

E. MANAGEMENT OF KEY PERSONNEL

Rating

F. CONTRACTUAL CONSIDERATIONS

Answer/Rating

Partially ________ Completely _________

*REMARKS

Please use this remarks block to provide explanatory narratives for any neutral, marginal, or unsatisfactory rating as well as for any Yes/No answer that is marked with an asterisk (*). These narratives need not be lengthy, just detailed.

PART 3: FOR COMPLETION BY PROPOSAL EVALUATOR:

If taken by phone, name and title of the person conducting the interview:______ _______________________________________________________Date:______