Past_Performance_Questionnaire.docx

Attachment J.1 Past Performance Questionnaire

The organization named below is asking you to be a past performance reference by completing this questionnaire. The Government refers to this organization as the Offeror. You are the client.

Name of Offeror:

This questionnaire is part of the Offeror’s response in a Government source selection. By requesting you to complete this questionnaire, the Offeror intends to use you as a reference for Government source selection evaluation purposes. The Government considers the information you provide here to be Source Selection Sensitive and confidential. The Government intends to use this data only for this source selection.

The Government asks that your answers to questions be honest and forthright, and that they be based only on your direct personal knowledge of the Offeror. The Government will not share your responses outside of this source selection. To ensure fairness and impartiality, you are to mail your completed and signed questionnaire directly to the Government at:

Office of Acquisitions Foreign Service Institute Department of State Washington, D.C. 20520-4201 ATTN: Aaron Tong

The Offeror is required to provide you prepaid and pre-addressed envelope(s). Be aware that the Offeror is not to participate in your questionnaire responses in any way whatsoever. As another option, you may e-mail your questionnaire to the Government to the Contracting Officer at tongaw@state.gov. If you e-mail your response back to the Government, please include the solicitation number (19FS1A19Q0027) in the subject line.

This questionnaire has three parts. The Offeror has to complete Part I. In Part I, the Offeror tells you the particular contract or project s/he wants to use as her/his reference. Part II is your responsibility. In Part II, the questionnaire asks you to provide performance information about the reference contract or project. Part III contains definitions to help you in your assessments. You’ll have to refer to these definitions to accurately complete the questionnaire.

If for any reason you are unable to complete this questionnaire, please complete Part II, Sections E and F and forward this questionnaire to the Government using the provided envelope or e-mail address.

Part I: Reference Background Information Part I of this questionnaire is to be completed by the Offeror.

Client and Reference Project/Contract Information (Completed by Offeror)

Period of Performance______________________

Part II: Past Performance Questions You are requested to complete Part II of this questionnaire, which involves filling out the client Assessment of Past Performance table below. There are five factors to address: Quality of Product/Service, Cost Control, Timeliness of Performance, Business Relations & Management, and Customer Service. You are to assess each factor and mark an X in the appropriate column in the table.

Please use the ratings scheme defined in Part III of this questionnaire. In addition, please study the performance category definitions, rating definitions, and the rating scheme found in Part III of this questionnaire before assessing client performance.

A. Client Assessment of Past Performance:

Factor I: Quality (Technical)

Contract Administration & Policies

Facility Requirements

Security/Safety Requirements

Lodging Requirements

Cleanliness Requirements

Shuttle Requirements

Factor 2: Quality (Site Visit)

Contract Administration & Policies

Facility Requirements

Security/Safety Requirements

Lodging Requirements

Cleanliness Requirements

Shuttle Requirements

Customer Service Delivery

Factor 3: Past Performance

Business Relations & Management

Quality of Product or Service

Customer Service Delivery

Timeliness of Performance

Factor 4: Price

Cost Control

If your rating for any factor is superior or poor, please provide supporting data as requested below.

Remarks on superior performance:

Provide data supporting this observation; you may continue on a separate sheet if needed.

Remarks on poor performance:

Provide data supporting this observation; you may continue on a separate sheet if needed.

B. Please identify any corporate affiliation you have with the Offeror:

C. Other comments that you wish to make: you may continue on a separate sheet if needed.

D. Would you do business with ______________________________________again?

E. If for any reason you are unable to complete this questionnaire please check this box and explain the reason/s why?

F. The following requests information about you. Please provide this information.

This questionnaire was completed by:

Client Name:____________________________________________________________

Title:_________________________________________________________________

Mailing Address (Street and P.O. Box): ______________________________________

City, State, and Zip Code:__________________________________________________

Telephone Number:_______________________________________________________

Fax Number:____________________________________________________________

Date Information Provided:_________________________________________________

Signature:___________________________________ Date:______________________

Part III: Elements within Each Rating Area

Quality of Product or Service

· Compliance with contract requirements

· Accuracy of reports

· Appropriateness of personnel

· Technical excellence

Cleanliness of Guest Rooms

· Guest room corridor floors, walls and ceilings are free of debris, marks, and damage.

· All guest room furniture, fixtures and equipment are clean, neat and well-maintained.

· Sink, tub, shower, toilet, bidet are very clean, free of hairs, stains and discoloration. Bathroom tile and grouting is clean, not discolored, cracked or mildewed.

· Faucets and drains operate smoothly and easily.

· Minimum bath linen is present: one bathmat; two each of facecloth, hand towel and bath towel.

· All towels are free of spots, stains, tears and obvious frays.

Cost Control

· Within budget

· Current, accurate and complete billings

· Costs properly allocated

· Unallowable costs not billed

· Relationship of negotiated costs to actual

· Cost efficiencies

Timeliness of Performance

· Reliable

· Operates on defined schedule

· Responsive to technical direction

· Completes work on time, including wrap-up and contract administration

· No liquidated damages assessed

Business Relations - Effective management

· Use of performance-based management techniques

· Business-like concern for the customer's interests

· Effective management and selection of subcontractors

· Effective small/small disadvantaged business subcontracting program

· Reasonable/cooperative behavior

· Effective use of technology in management and communication

· Flexible

· Minimal staff turnover

· Maintains high employee morale

· Resolves disagreements without being unnecessarily litigious.

Customer Service

· Understands and embraces service and program goals

· Team approach with the customer

· Satisfaction of end users with the contractor’s service

· Positive customer feedback

· Prompt responses

· Courteous interactions

· Effective escalations and referrals

· Initiative and proactive improvements

· Creative service strategies

Rating Guidelines

Quality of Product or Service

Cost Control

Timeliness of Performance

Business Relations

Customer Service