2.2.1 Proposal Attachment 4 Technical Evaluation Document Past Performance Questionnaire.docx
DOCX document 36 KB Posted
- Solicitation number
- 70FBR427R00000001
About this file
This is a Past Performance Customer Questionnaire template designed to evaluate contractor performance on federal contracts, specifically for this FEMA Level II Armed Guard Security Services solicitation (70FBR427R00000001). The questionnaire is completed by government agencies or companies who have previously worked with the contractor and serves as source selection sensitive information submitted directly to the Contracting Officer, Mimie Preston at DHS/FEMA (202-679-9274, mimie.preston@fema.dhs.gov).
The questionnaire requires references to provide ratings across three primary evaluation categories: Quality of Service (compliance with contract requirements, technical excellence, budget adherence), Timeliness of Delivery (milestone achievement, reliability, schedule performance), and Overall Customer Satisfaction (effective management, communication, responsiveness, and flexibility). Each category uses a five-point scale: Unsatisfactory, Poor, Fair, Good, or Excellent, with detailed guidance provided for each rating level. The form also requests basic contract information including contractor name, solicitation/contract number, period of performance, overall contract value, contract type (Firm Fixed Price, Cost Reimbursement, or Other), work complexity, and a final recommendation on whether the reference would select the contractor again. References must provide their name, title, date, and contact information, with additional documentation attachable if necessary.
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Section J Attachment # Page 1of 2
Contract Performance Customer Questionnaire
1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than 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.
ATTN: Mimie Preston, Contracting Officer DHS/Federal Emergency Management Agency Phone: 202-679-9274 Email: mimie.preston@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. Timelines 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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