B08_Attachment__5_Past_Performance_Questionnaire-1.pdf

For Official Use Only/Source Selection Information Revised 29 Mar 2023 by WCO Team 3

Performance Past Performance Questionnaire Project Name:

IDIQ – Insurance Consulting

Solicitation Number:

140P2124R0030

Contracting Point of Contact Juliann Ashcroft NPS – ConOps Contracting Office Juliann_ashcroft@nps.gov

Instructions:

1) The offeror is to complete only the information in Section A, then send the entire past performance questionnaire to project owner for completion.

2) The project owner (or reference) is to complete Section B, then send the entire past performance questionnaire back to the offeror to be provided with their complete proposal package, which will then be reviewed for evaluation.

3) The past performance questionnaire must be received by the contracting point of contact by the date and time specified in the solicitation (or any amendments). Please note that for electronic submissions, offerors should consider and account for potential delays in transmissions between when an electronic submission is submitted and when an electronic submission is received. Late past performance questionnaires will not be accepted.

4) One past performance questionnaire is to be used for each past performance project submitted. The offeror may submit between 3-5 past performance questionnaires for this solicitation. Past performance projects must have been completed within five years of the completion of performance of the evaluated contract or order.

Notice to Contractor

Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.

This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the Government to be superior to other products or services.

The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.

Section A – To be completed by the offeror

The project information in Section A shall reference the past performance project, not the solicitation project. The description of the work performed must be sufficiently detailed for Government to make a determination of relevance in size, scope, and complexity of each project listed to the work described in this solicitation.

Offeror’s Company Name:

DUNS Number or UEI Number:

Project Name:

(Name of the past performance project)

Project Completion Date:

Project Value:

Description of the work completed by the offeror:

Describe the relevancy of the past performance project to the work required in the solicitation:

Section B – To be completed by the project owner (or reference)

The information provided by the project owner may be verified by contacting references as deemed necessary by the Government.

Project Owner Company Name or Department:

Project Owner Point of Contact:

Name and Title/ Position

Point of Contact Phone Number:

Point of Contact email Address:

Past Performance Rating Scale

Rating

Definition

Excellent

Performance considerably exceeded requirements/expectations.

Good

Performance exceeded requirements/expectations.

Satisfactory

Performance met the requirements/expectations. If any minor problems occurred, corrective actions taken by the contractor were satisfactory.

Marginal

Performance did not meet some contractual requirements and reflects a serious problem in the element being assessed.

Unsatisfactory

Did not meet requirements/expectations. The element being assessed contained a serious problem(s) for which the contractor’s corrective actions were ineffective.

Section B CONTINUED - To be completed by the project owner (or reference)

Past Performance Rating Select applicable rating

Ex ce lle nt

G oo d

Sa tis fa ct or y

M ar gi na l

U ns at is fa ct or y

N ot

A pp lic ab le

Quality of workmanship, including subcontractors work

Conformance with contract requirements

Resolved any issues that occurred

Management of overall project and subcontractors

Adhered to performance period, completed work on time

Responded to owner requests in a timely manner

Conducted business-like cooperation with the project owner and communicated well with all project shareholders – ie: provided documentation timely, ensured minimal errors in documentation, responsive to both owner and contracting office, etc.

Yes No Overall, the Project Owner was satisfied with the services performed for this project

Based on the experience with this contractor for this project, I would recommend them for similar contracts

Comments (may provide additional pages for comments):

Signature of Project Owner Point of Contact:

Once completed and signed, the project owner (or reference) is to submit the entire completed past performance questionnaire back to the offeror to be provided with their complete proposal package, which will then be reviewed for evaluation.