Past_Performance.docx

PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE

Name of Offeror:

Reference Information Table Business Name of reference & address

Point of Contact

Phone number

E-mail address

Contract or Purchase Order Number

Dollar Value

Period of Performance

Description of Services Performed

Explain any problems and resolutions

By submitting a questionnaire to its’ business references, the offeror authorizes the government to discuss past performance with the business reference identified in the table above.

Evaluation KEY: Please use the following abbreviations to assign an applicable rating for questions 1 thru 6 below:

Poor/ Unsatisfactory

Does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas; deficiencies in one or more areas which adversely affect overall performance.

Meets or slightly exceeds minimum acceptable standards; adequate results; reportable deficiencies with identifiable, but not substantial, effects on overall performance.

Effective performance; fully responsive to contract requirements; reportable deficiencies, but with little identifiable effect on overall performance.

Very effective performance; fully responsive to contract requirements; contract requirements accomplished in a timely, efficient, and economical manner for the most part; only minor deficiencies with minimal effect on overall performance.

Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall performance.

No record of relevant past performance or past performance information is not available

1. How would you rate the contractor’s compliance with the delivery schedule / performance milestones?

Comments:

P/U|_| S|_| G|_| VG|_| E|_| N|_|

2. How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?

3. How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service?

4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

5. How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?

6. How would you rate the contractor’s overall performance?

7. Would you purchase services from this contractor again?

Comments:.

|_| YES |_|NO

Please provide any additional comments applicable to the contractor’s past performance:

EVALUATOR’S NAME:

TITLE OF EVALUATOR:

DATE: _________________

PLEASE RETURN DIRECTLY TO THE CONTRACTING OFFICER: Ms. Abbie Jemmott at ajemmott@cdc.gov.

Forms Submitted Directly by the Contractor Will Not Be Accepted.