20240307_Attachment_4_Past_Performance_Questionnaire.pdf

CUI

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ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

W911SD24R0081

Solid Waste Management Services, United States Military Academy, West Point NY

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor:

B. Cage Code:

C. Contract number:

D. Contract type:

E. Was this a competitive contract? Yes No

F. Period of performance:

G. Initial contract cost: $

H. Current/final contract cost: $

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SOURCE SELECTION INFORMATION (SEE FAR 3.104)

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SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other

Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

D. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

Performance Assessment Questionnaire

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A. CONTRACT IDENTIFICATION

B. IDENTIFICATION OF OFFERORS REPRESENTATIVE

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does and notify the Contracting Officer. Please return the completed Questionnaire to the Contracting Officer identified in the cover letter within the stated timeframe.

PART I. (To be completed by the Offeror)

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor

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A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

B. Effectiveness of Project Management (to include use and control of subcontractors).

problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements.

Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

Neutral Confidence: No recent/relevant performance record is available or the offerors performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

*Note: rationale is required for each response.

Substantial Confidence

Satisfactory Confidence

Limited Confidence

No Confidence

Neutral Confidence

Rationale:

Substantial Confidence

Satisfactory Confidence

Limited Confidence

No Confidence

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D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

E. General Comments. Provide any other relevant performance information.

F. Other Information Sources. Please provide the following information:

Neutral Confidence

Rationale:

Substantial Confidence

Satisfactory Confidence

Limited Confidence

Limited Confidence

Comments:

C. Timeliness of Performance for Services and Product Deliverables.

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G. Respondent Identification. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name):

Telephone Number:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please email completed questionnaire to MICC- West Point Contract Specialist at:

lakenia.m.brown.civ@mail.mil Thank you for your prompt response and assistance!

Thank you for your assistance.

Performance Assessment Questionnaire – Telephone Interview

Contractor: Contract No.:

Subcontract No. (if applicable):

POC: Title:

(Name) (E.G. PCO/ACO/TM)

(Agency, Telephone No., E-mail & Facsimile No.)

If conducting a telephone interview:

“Hello, I am . I am calling in reference to Contract with a company called . My questions will pertain to the contractor’s record of past, which is defined as within the past three years, and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. A summary of this discussion may be sent to you for your records.

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A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Please provide examples and/or explanations, and utilize the following ratings:

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements.

Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

Neutral Confidence: No recent/relevant performance record is available or the offerors performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

PART I. EVALUATION (To be completed by Point of Contact – Respondent)

*Note: rationale is required for each response.

Limited Confidence

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C. Timeliness of Performance for Services and Product Deliverables.

D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Limited Confidence

Limited Confidence

Limited Confidence

B. Effectiveness of Project Management (to include use and control of subcontractors).

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F. Other Information Sources. Please provide the following information:

G. Respondent Identification. Please provide the following information:

Comments:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name):

Telephone Number:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART II. RECORD OF INTERVIEW (To be completed by PPT Member)

( ) Discussed recentness and relevance of information ( ) Read summary to person contacted Date:

( ) Sent copy to person contacted Date:

PPT Member Signature Typed or Printed Name

Telephone Fax

E. General Comments. Provide any other relevant performance information.