Attachment C Past Performance Questionaire RFQ 20156753.docx

CBP Fingerprinting Requirement Attachment C Past Performance Questionnaire

The quoter shall complete Sections A and B of the questionnaire below. The quoter’s reference shall complete Section C of the questionnaire below and submit directly to richard.m.kirby@cbp.dhs.gov no-later-than April 4, 20126 at 12:00 PM Eastern Time.

A. Contractor/Quoter Information:

Company Name:

Division Name:

Street Address:

City, State, Zip Code:

NAICS Code:

B. Contract/Project/Task Order Information: Complete the general contract information below.

1. Period of Performance Being Assessed (contracts ongoing or completed within last three years):

2. Contract Number:

3. Contracting Office:

4. Location of Contract Performance:

5a. Contracting Officer:

5b. Phone Number:

6a. Contract Award Date:

6b. Contract Effective Date:

7. Contract Completion Date:

8. Awarded Dollar Value:

9. Current Contract Dollar Value:

10. __Competitive ___Non-Competitive

11. Contract Type: ___FFP ___FPI ___FPR ___CPFF ___CPIF ___CPAF __ OTHER MIXED/OTHER:

12. Key Subcontractors (with DUNS and CAGE) and Effort Performed:

13. Small Business Utilization:

13a. Does this contract include a subcontracting plan?

13b. Is small business subcontracting under this contract included in a comprehensive small business subcontracting plan?

13c. Is small business subcontracting under this contract included in a commercial small business subcontracting plan?

13d. Date of last Individual Subcontracting Report (ISR) / Summary Subcontracting Report (SSR):

C. Past Performance Survey: In connection with a pending solicitation, the Government must evaluate the above-listed contractor’s capability and capacity to successfully perform certain requirements. To assist this evaluation, please assess the contractor’s performance on your contract, task order or project using the following ratings in your assessment. Please include comments in the “Narrative” space provided to explain each rating given. You may be contacted to clarify comments and/or ratings:

Exceptional – Performance exceeded the contract requirements in most cases. No problems were encountered.

Very Good - Performance met, and in some cases exceeded the contract requirements. If there were any problems they were minor in nature, which the contractor resolved in a timely, effective manner.

Satisfactory – Performance met the contract requirements. There were some minor problems which the contractor resolved in a timely, effective manner.

Marginal - Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

Unsatisfactory - Performance did not meet most of the contractual requirements. There were numerous problems of a serious nature, for which corrective action was ineffective.

Unknown - No record of past performance or the record is inconclusive.

1. Quality of Service

Exceptional Very Good Satisfactory Marginal Unsatisfactory Unknown or N/A

NARRATIVE:

2. Schedule Control

Very Good Satisfactory Marginal Unsatisfactory

3. Cost Control

Very Good Satisfactory Marginal Unsatisfactory

4. Federal Information Security Controls (i.e., successfully completing a Federal Security Authorization process leading to an Authorization to Operate (ATO), as governed by the Federal Information Security Management Act (FISMA)) and/or related Federal requirements.

Exceptional Very Good Satisfactory Marginal Unsatisfactory

5. Management of Key Personnel

Exceptional Very Good Satisfactory Marginal Unsatisfactory

6. Utilization of Small Business Concerns

Exceptional Very Good Satisfactory Marginal Unsatisfactory

7. Adapting to Change

Exceptional Very Good Satisfactory Marginal Unsatisfactory

8. Transition-in / Transition-out (i.e., the efficiency and effectiveness of beginning and ending a contractual engagement, and level of cooperation with the government and/or other service providers).

Exceptional Very Good Satisfactory Marginal Unsatisfactory

RECOMMENDATION: Given what I know today about the Contractor's ability to execute what they promised in their proposal, I (choose from an option below) award to them given that I had a choice.

Definitely Would Probably Would Probably Would Not Definitely Would Not

Assessing Official Name:

Assessing Official Title:

Assessing Official Phone #:

Assessing Official Email Address:

Assessing Officials Agency:

Assessing Official’s Signature: