Attachment_i_-_Past_Performance_Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and email:Kadian.Ferguson@FCC.Gov

When complete, the information on this form is SOURCE SELECTION INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1. A. CONTRACTOR NAME & ADDRESS:

1.B. NAME OF PRIME OFFEROR, if this questionnaire is for a team member:

2. CONTRACT/SUBCONTRACT NO.:

3. CONTRACT/SUBCONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT/SUBCONTRACT VALUE (with options):

6. TYPE OF CONTRACT (Fixed Price, GMP, FPI, etc.):

7. PROJECT TITLE, LOCATION, AND DESCRIPTION (INCLUDING TOTAL CONSTRUCTION VALUE):

Please add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE

NUMBER:

c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

9. Please circle the response code for each topic (A – F) that best reflects your experience with this contractor.

O = Outstanding E = Excellent

A = Acceptable M = Marginal

U = Unacceptable N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship.

O E A M U N/O B. Schedule – Assess the timeliness of contractor against the schedule of activities.

O E A M U N/O C. Performance Requirements – Assess the contractor’s ability to fulfill the performance requirements of the contract.

O E A M U N/O D. Resource Management – Assess the contractor’s ability to provide and maintain personnel and other resources for the contract.

O E A M U N/O E. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

F. Overall Performance Assessment

O

E

A

M

U

N/O

10. If this was an award fee contract, what was the average award fee % earned?