food_Service_-PPQ.docx

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Food Service at the National Mine Health and Safety Academy
Solicitation number
1645BC-19-R-00004
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Past Performance Questionnaire

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PAST PERFORMANCE EVALUATION QUESTIONNAIRE

1645BC-19-R-00004

SECTION A: Contractor Information (to be completed by the Contractor requesting the evaluation prior to forwarding)

A. Contractor’s name and address:

B. Point of contact::

C. Phone number (with area code):

D. Contract number:

E. Project title or description of work performed under this project:

F. Contract type:

|_| Firm- Fixed Price |_| Indefinite-Delivery/Indefinite Quantity Task Order |_| Cost-Reimbursement

G. Contract award date:Scheduled completion date:
H. Contract award amount:Current/final project amount:

I. Contractor being evaluated performed as the:

|_| Prime Contractor |_| Subcontractor |_| Supplier on this contract/order J. Authorization is hereby granted to provide the information requested in Section B of this questionnaire.

(Signature)

(Name and title of Authorizing Official) (Date)

SECTION B: Respondent Information (to be completed by the Respondent/Reference)

EVALUATED BY:

(Signature) (Date)

Organization:

(Typed or Printed Name)

Address:

(Title)

(E-mail Address) Phone Number:

NOTE: The identity of individual(s) providing the reference information shall not be disclosed.

PERFORMANCE RATING QUESTIONNAIRE

(Contractor to forward to their reference for completion)

(This questionnaire, when completed, shall be treated as Source Selection Sensitive in accordance with FAR 3.104-3 and shall not be disclosed to anyone outside the Government)

The rating definitions are as follows:

U
M
S
V
E
N

Unsatisfactory/ No Confidence Marginal/Little Confidence Satisfactory/ Confidence Very Good/Significant Confidence Exceptional/ High Confidence Neutral/ Unknown Confidence

Based on the Offeror’s performance record, extreme doubt exists that the Offeror will perform the required effort.

Based on the Offeror's performance record, substantial doubt exists that the Offeror will perform the required effort.

Based on the Offeror's performance record, some doubt exists that the Offeror will perform the required effort.

Based on the Offeror's performance record, little doubt exist that the Offeror will perform the required effort.

Based on the Offeror's performance record, essentially no doubt exist that the Offeror will successfully perform the required effort.

No performance record identifiable

The contractor:

1
How efficient was the contractor in abiding by all Rules, Regs, Laws, and Safety Standards?
U
M
S
V
E
N
N/A
2
Were you satisfied with the quality of service performed or items supplied?
U
M
S
V
E
N
N/A
3
How effective were the contractor's quality control and/or inspection procedures?
U
M
S
V
E
N
N/A
4
How well did the contractor perform in a timely manner and schedule?
U
M
S
V
E
N
N/A
5
How well did the contractor resolve Issues/ Problems/Customer Complaints?
U
M
S
V
E
N
N/A
6
Was flexible, cooperative and reasonable in meeting mission requirements, particularly when faced with short-notice mission changes
U
M
S
V
E
N
N/A
7
Paid employees, subcontractors and suppliers in a timely manner
U
M
S
V
E
N
N/A
8
Contractor was able to maintain a good relationship with agency contracting and technical/project management personnel
U
M
S
V
E
N
N/A
9
How likely are you to award another contract to this contractor?

1 = Not at all likely 2 = Some doubts 3 = Somewhat likely 4 = Likely 5 = Very likely

1
2
3
4
5
10
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes explain outcome in `remarks' section below.
NO
YES

ADDITIONAL REMARKS:

*Please forward this questionnaire directly to mckeever,jennifer@dol.gov by May 10, 2019 at 1:00 PM.

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