2.2.1 Attachment III - Past Performance Questionnaire.pdf
PDF 173 KB Posted
- Solicitation number
- 70FB7026R00000013
- Issued by
-
Federal Emergency Management Agency
About this file
This document is a Past Performance Questionnaire template issued by the Federal Emergency Management Agency (FEMA) under the Department of Homeland Security for a Request for Proposal (RFP) titled "Disaster Overseas Transportation Support." The questionnaire is designed to collect reference information from previous customers or contract officers regarding an offeror's performance on similar contracts.
The questionnaire requires evaluators to rate contractor performance across three key elements: Quality of Service, Customer Satisfaction, and Timeliness of Performance and Completion of the Contract. Each element uses a three-tier rating scale (Neutral, Satisfactory, or Unsatisfactory) with defined standards. Satisfactory indicates the contractor is likely to successfully perform required efforts; Unsatisfactory indicates past performance deemed not relevant or unlikely to support successful performance; and Neutral indicates no relevant performance record could be identified. Evaluators must also respond to whether they would do business with the contractor again (Yes, No, or Unsure) and provide supplemental comments for each performance element. Completed questionnaires must be submitted electronically to the Contracting Officer, Karley Hoyt (karley.hoyt@fema.dhs.gov), and Contract Specialist, Jason Rivers (jason.rivers@fema.dhs.gov) by the solicitation closing date. The form requires certification from the evaluator and maintains confidentiality of reference providers in accordance with federal law.
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Attachment III – Past Performance Questionnaire
Past Performance Questionnaire
The Department of Homeland Security (DHS), Federal Emergency Management
Agency (FEMA), recently released a Request for Proposal for Disaster Overseas
Transportation Support. Offerors were asked to provide information contracts similar in nature, size and complexity to the present requirement on which they performed in the past. An Offeror has submitted this to you as a reference for past performance (see
Sections B and C below).
FEMA is requesting your opinion on how well the contractor performed on your contract(s). Please fill out the questionnaire and send an electronic copy to the
Contracting Officer, Karley Hoyt at karley.hoyt@fema.dhs.gov and Contract Specialist, Jason Rivers at jason.rivers@fema.dhs.gov .
To be considered, this form must completed in its entirety and received by the
Contracting Officer no later than the closing date and time of the solicitation. FEMA may contact you to clarify or verify any information provided. For purposes of confidentiality, only send the completed questionnaire to the FEMA Contracting Officer and Contract
Specialist identified above. Your input will remain confidential.
Please note, your comments will be used to form the basis of evaluation of the requesting Offeror.
Thank you in advance for your assistance. If you have any questions, please contact the Contracting Officer or Contract Specialist identified above.
A. Instructions
Two forms are provided to document your opinion: 1) Performance Rating Form; and 2)
Supplemental Comment Form. Please fill out both forms in accordance with the instructions provided on each. Please use the following standards in terms of your rating:
1. Satisfactory: Based on the offeror’s relevant past performance record, it is likely that the offeror will successfully perform the required effort.
2. Unsatisfactory: Based on the offeror’s past performance record, which is deemed not relevant, it is not likely that the offeror will successfully perform the required effort.
3. Neutral: No relevant performance record is identifiable upon which to base a meaningful performance rating. A search was unable to identify any relevant past performance information for the offeror or subcontractors. This is neither a negative nor positive assessment.
mailto:karley.hoyt@fema.dhs.gov mailto:jason.rivers@fema.dhs.gov
B. 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.
Contractor Name
Contractor Phone
Contractor Email
Contractor Address
Contract Title
Contract Number
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS
QUESTIONNAIRE IS ACCURATE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE.
Evaluators Name
Evaluators Title
Evaluators Email
X Evaluators Signature and Date
C. Evaluation Ratings and Supplemental Comments
Performance Element Neutral Satisfactory Unsatisfactory
Quality of Service: The contractor provided a high quality of service.
Customer Satisfaction:
The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.
Timeliness of Performance and Completion of the Contract: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time and safely.
Yes No Unsure
Given the choice, would you do business with this contractor again?
Supplemental Comments:
Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. Please add additional pages as necessary.
Quality of Service:
Customer Satisfaction:
Timeliness of Performance and Completion of the Contract:
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