2.2.1 Attachment C – Past Performance Questionnaire.DOCX
DOCX document 25 KB Posted
- Attached to
- Replace the outdated HVAC system in the Federal Regional Center (FRC) building in Denton, TX
- Solicitation number
- 70FBR622Q00000046
- Issued by
-
Federal Emergency Management Agency
About this file
This document includes a past performance questionnaire template and details of a federal contract opportunity to replace an outdated HVAC system. The opportunity is a combined synopsis and solicitation issued by the Federal Emergency Management Agency for a contractor to provide labor, materials, supplies and equipment to replace the HVAC system in the Federal Regional Center building in Denton, Texas. The 100% small business set-aside contract value is unspecified. Offerors must visit the site on August 30th between 9AM and 1PM CDT and coordinate the visit at least 24 hours in advance with the identified point of contact. The past performance questionnaire requests information about a contractor's performance on similar prior contracts and will be used to evaluate offerors for this opportunity, with responses due by September 6th, 2022.
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Text version
Section J Attachment C Page 1of 2
Contract Performance Customer Questionnaire Response required by September 6, 2022 at 4:00PM EDT
1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information and will be sent directly to the Contract Specialist. This information is not to be released to the offeror. Completed questionnaires may be emailed to:
| ATTN: Felicia Castillo, Contracting Officer |
| Texas National Processing Service Center |
DHS/Federal Emergency Management Agency Phone: (202) 803-1676 | Email: felicia.castillo@fema.dhs.gov
2. Please complete:
Company/Contractor Requesting Reference
Agency/Company Name Providing Reference
Company/Contractor Name
Agency/Company Name
Point of Contact Name
Point of Contact Name
Phone #
POC E-mail / Phone #
E-mail address
Period of Performance
Fax Number
Supply/Service Provided
PAST PERFORMANCE RATING GUIDELINES
Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Poor, Fair, Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”
N/A - NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.
| Ratings |
| Quality of Service |
-Compliance w/contract requirements -Technical excellence -Within budget -Relationship of negotiated costs to actual Timeliness of Delivery -Met interim milestones -Reliable -Delivery Schedule achieved Overall Customer Satisfaction -Effective Management -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable/cooperative -Flexible -Pro-active
| Unsatisfactory |
| Nonconformances |
are comprising the achievement of contract requirements
| Delays are compromising achievement of contract requirements |
| Response is not effective |
| Poor |
| Nonconformances |
require major agency resources to ensure achievement of contract requirements
| Delays require major agency resources to ensure achievement of contract requirements |
| Response is marginally effective |
| Fair |
| Nonconformances require minor agency resources to ensure achievement of contract requirements |
| Delays require minor agency resources to ensure achievement of contract requirements |
| Response is somewhat effective |
| Good |
| Nonconformances |
do not impact achievement of contract requirements
| Delays do not impact achievement of contract requirements |
| Response is usually effective |
| Excellent |
| There are no quality problems |
| There are no delays |
| Response is effective |
PAST PERFORMANCE QUESTIONNAIRE
| 1. Company/Contractor Being Referenced: |
| 2. Solicitation/Contract Number: |
| 3. Address: | |
| 4. Contract Type: | |
| |_| | Firm Fixed Price |
| |_| | Cost Reimbursement |
| |_| | Other (Please Specify) |
| 5. Agency/Company Completing Reference: |
| 6. Agency/Company POC, Phone & Fax: |
7. Period of Performance:
8. Overall Contract Value: $
9. Title of Contract:
10. Description of Contract Service:
11. Complexity of Work: Difficult: |_| Routine: |_|
NOTE: Please use adjectival ratings from attached sheet.
| 12. Evaluation Factor |
| 13. Rating |
| 13. Comments (Attach additional sheets, if necessary.) |
a. Quality of Service
b. Timeliness of Delivery
c. Overall Customer Satisfaction
15. Would you select this company/contractor again? Please explain. (Attach additional sheet if necessary.)
16. Name & Date:
17. Title:
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