Past_Performance_Questionnaire.doc

Past Performance Questionnaire

SOCIAL SECURITY ADMINISTRATION

CONTRACTOR PERFORMANCE EVALUATION SURVEY

The purpose of this survey is to obtain information regarding the quality of the (below) named contractor’s (offeror’s) past performance relative to a contract (completed or in progress) at your company/agency. Social Security Administration (SSA) requests the Reference Agency submit the completed Past Performance Questionnaire to Molly.Seipp@ssa.gov no later than 2:00pm ET on March 28, 2019. SSA may validate the information included in the survey by contacting the reference provided.

Offeror Completes the Yellow Sections Below

Name and Address of Contractor (Offeror):

Contractor (Offeror’s) E-Mail address and Contact Information:

Contract Number or Project Title:

Contract or Project Period of Performance (fill in date contract began, and anticipated completion date):

Reference Agency / Company

Completes the Blue Sections Below

Name of Agency/Company completing this Survey:

· No

· N/A – Not a federal contract reference

Name of Person Completing this Survey:

Email address and Contact Information of Person Completing this survey:

Brief Description of Services Provided:

Contract Type (FFP, FP-EPA, IDIQ, Labor Hours, etc.):

Contract Start Date:

Contract Completion Date (if all options exercised):

Annual Contract Value:

Total Contract Value inclusive of all options, if exercised

The Below Rating Chart provides a brief description of what justifies each of the adjectival ratings and is consistent with the rating system utilized in the Contractor Performance Assessment Reporting System (CPARS). Please use this chart when selecting your ratings in each of the categories.

Source Selection Information -- See FAR 3.104

PERFORMANCE RATING GUIDELINES

TIMELINESS OF PERFORMANCE

Management of Key Personnel

BUSINESS RELATIONS

Exceptional

Performance meets contractual requirements, and exceeds many contractual requirements to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

Very Good

Performance meets contractual requirements, and exceeds some contractual requirements to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective

Satisfactory

Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory

E=Exceptional VG =Very Good S=Satisfactory M=Marginal U=Unsatisfactory

1. The contractor provided a product or service that conformed to contract requirements, specifications, and standards of good workmanship.

2. The contractor provided an effective quality control plan/program.

3. The contractor utilized personnel that were properly trained and experienced.

4. How would you rate the contractor’s commitment to customer satisfaction?

5. The contractor was reliable and responsive to technical direction.

6. Contract deliverables were completed and provided timely and in accordance with contract schedules.

7. The contractor adhered to contract schedule, there were no deductions taken for timeliness issues.

8. How well did the contractor match the qualifications of the key position, as described in the contract, with the person who filled the key position?

11. The contractor demonstrated effective and efficient management.

12. The contractor cooperated with the government in providing flexible, proactive, and effective solutions to issues.

13. The contractor promptly notified the government in a timely manner regarding urgent issues.

14. The contractor was successful in recruiting and maintaining qualified and reliable personnel.

15. The product/services adequately met the needs of the government, and I am satisfied with the performance of the contractor under this effort.

How would you rate the contractor’s overall performance on this effort?

NO

Additional comments are greatly appreciated:

Note to Agency Completing Reference – Please complete this form and return to Molly.Seipp@ssa.gov no later than 2:00pm ET on March 28, 2019. Thank you for your participation.