Past Performance Survey_Attachment A.doc

U.S. DEPARTMENT OF STATE

PAST PERFORMANCE SURVEY

CONTRACT INFORMATION

a. Contractor:

b. Contract Number:

c. Type of Contract: (check all that apply) i.

( ) Negotiated ( ) Sealed Bidding ii.

( ) Competitive ( ) Non-Competitive iii.

( ) Firm-Fixed-Price ( ) Cost-Plus-Fixed-Fee

( ) Time-and-Materials ( ) Labor Hour

( ) Indefinite Quantity ( ) Requirements

Other: __________________________________

d. Please complete the following:

Period of Performance: _________________ to ___________________

Initial Contract Value:

Current (or Completed) Contract Value

e. Brief description of requirement:

f. Complexity of effort: ( ) Difficult ( ) Routine

Please provide the following information (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Name of Evaluator: ____________________________________

(Customer Contact)

Telephone Number: ____________________________________

Facsimile Number: _____________________________________

Organization/Office Symbol: _____________________________

Mailing Address: ______________________________________

Position Title: ___________________________________

Length of involvement with contract: ______________________

Degree or extent of involvement with contract: ______________

Thank you in advance for completing this survey.

SCORING CRITERIA

EXCEPTIONAL - Indicates the Contractor’s performance within the area of evaluation clearly and consistently exceeds contractual requirements.

ACCEPTABLE - Indicates no problems in area of evaluation or has only minor problems for which solutions were satisfactory.

MARGINAL – Indicates problems in the evaluation area. The contractor may have been in possible danger of being unable to meet contractual requirements, recovery was untimely.

UNACCEPTABLE - Indicates serious problems in the evaluation area. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur.

NOT APPLICABLE – Unable to provide rating for this area. The contract did not include performance from this aspect.

I. CONFORMANCE TO SPECIFICATIONS AND STANDARDS OF GOOD SKILL

1a. Overall ability to pro-actively and aggressively perform contract requirements.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

1b. Effectiveness and reliability of contractor’s Key Personnel.

Marginal

Unacceptable

Comments: ______________________________________________________

II.

ADHERENCE TO CONTRACT SCHEDULES

2a. Overall performance in planning, scheduling, and monitoring.

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

2b. Completion of major milestones on schedule.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

2c. Timely completion of efforts within period of performance.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

III.

COMPLIANCE WITH TERMS AND CONDITIONS OF THE CONTRACT

3a. Successful in meeting small business subcontracting goals Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

3. b. Ensuring compliance with EEO regulation(s) Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

IV.

CONTRACT COST MANAGEMENT

4a. Quality, completeness, and accuracy of price/cost proposals

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

4b. Accuracy and timeliness of cost reports.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

4c. Ability to perform within negotiated costs/prices.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

V. GENERAL BUSINESS CONDUCT AND BUSINESS-LIKE CONCERN FOR THE CUSTOMER

5a. Ability to effectively manage contract.

Marginal

Unacceptable Comments: ______________________________________________________

5b. Ability to choose and manage subcontractors.

Please circle the appropriate rating below or check ( if N/A:

Exceptional Acceptable

Marginal

Unacceptable Comments: ______________________________________________________

BASED ON THIS CONTRACTOR’S OVERALL PERFORMANCE, WOULD YOU AWARD THIS CONTRACTOR ANOTHER CONTRACT? ( YES ( NO

If no, please explain: _____________________________________________

PLEASE USE THE SPACE BELOW TO PROVIDE ANY ADDITIONAL COMMENTS CONCERNING THE PAST PERFORMANCE OF THE CONTRACTOR:

Survey Completion Date: ____________________________

Thank you for completing this past performance evaluation.. Please email this completed form to Adrienne Bell @bellam@state.gov. Thank You, ATTN: Adrienne Bell

Phone: 703 516-1667

SOURCE SELECTION INFORMATION SEE FAR 2.101 & 3.104

WHEN COMPLETED FOR OFFICIAL USE ONLY