2.2.1 Attach 3 Past Performance Questionnaire.doc

ATTACHMENT _______

FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)

SOLICITATION NUMBER_________

PAST PERFORMANCE QUESTIONNAIRE

PROJECT TITLE: ____________

DATED 2/24/2021

Project Description: _______________ Offerors were asked to provide information on for relevant work that has started within the past 5-years from date of issuance of the synopsis for this requirement. An Offeror submitted you as a reference for past performance. We need your opinion on how well the contractor performed on this contract. Please fill out this past performance reference form and submit via email to the Contracting Officer, ___________at____________and Contract Specialist, ______________ at __________________ by due date of _______________10:00 AM (local time, Washington, DC).

Your input will be confidential. Please note your comments will be used to form the basis for evaluation of this offeror. Thank you in advance for your assistance.

CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Page 1 of 4 Pages

FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)

PAST PERFORMANCE QUESTIONNAIRE

PROJECT TITLE: PTS

Block 1. Contractor/Reference & Period of Performance|

Block 2. Contract Number/Task Order Number (if applicable) (being rated) |

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Evaluator’s Printed Name

Title

Evaluator’s Mailing Address (Agency, Bldg/Room, Street, City, State, and Zip)

Evaluator’s Signature Date

Phone email

INSTRUCTIONS

Two forms are provided to document your opinion: 1) Performance Rating Form; and 2) Supplemental Comment Form. Please fill out each form in accordance with the instructions provided on each. Please use the following standards in arriving at your rating:

Exceptional - Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective

Very Good - Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory – Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal - Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Other - The element is not applicable, no data has been obtained, or additional comments are provided.

Page 2 of 4 Pages

FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)

PAST PERFORMANCE QUESTIONNAIRE

PROJECT TITLE: PTS

Performance Rating Form

1. QUALITY OF WORKD: The contractor provided high quality of service and performed successfully.

2. COST CONTROL AND EFFECTIVE AND EFFICIENT USE OF RESOURCES: The contractor deployed, in a timely manner, the proper amount and type of personnel, facilities and other resources to support the project. Use of subcontractors was appropriate in supporting the project. The contractor successfully planned and proposed realistic costs and monitored performance, and consistently operated at or below budget.

3. SCHEDULE/TIMELINESS OF PERFORMANCE: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time.

4. MANAGEMENT. The contractor managed the contract in and effective and efficient manner and exhibited a commitment to customer satisfaction. The contractor exhibited reasonable and was responsive to client changes, criticism/rejection of contract deliverables and in detecting and correcting errors, poor performance, and other problems.

5. SMALL BUSINESS SUBCONTRACTING: The contractor complied with small business subcontract plan requirements and strived to meet small business subtracting goals in good faith.

YES

NO

6. Given the choice would you do business with this contractor again?

Page 3 of 4 Pages

DHS/FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)

PAST PERFORMANCE QUESTIONNAIRE

PROJECT TITLE: PTS

Supplemental Comment Form

Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. Please add additional pages as necessary.

Performance Element #1, Quality of Services:

Performance Element #2, Cost Control and Effective and Efficient Use of Resources:

Performance Element #3, Schedule/Timeliness of Performance:

Performance Element #4, Management, Business Relations, Customer Satisfaction

Performance Element #5, Small Business Subcontracting Page 4 of 4 Pages