Past_Performance_Questionnaire.doc

Past Performance Questionnaire

Solicitation No. 28321319Q00000093

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 Lindsay.Hrybyk@ssa.gov, no later than 12:00 pm EDT on Tuesday, December 4, 2018. 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’s (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 Completes the Blue Sections Below

Name of Agency/Company completing this Survey:

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, Time-and-Materials, 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

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 were 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 were effective

Satisfactory

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were 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.

Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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 accurate and complete reports and deliverables.

3. The Contractor’s work measures up to commonly accepted technical or professional standards.

4. Minimum Government technical direction was required to solve problems that arose during contract performance.

5. The Contractor utilized Personnel that were properly trained, certified, licensed, and experienced.

6. The Contractor provided an effective quality control plan/program.

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

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

9. The Contractor adhered to the contract/BPA/call order schedule, there were no deductions taken for timeliness issues.

10. The Contractor controlled costs for the referenced contract/task order and took immediate corrective action as needed to address potential issues.

11. The Contractor’s innovation with the contract/BPA/call order resulted in cost savings.

12. The Contractor’s billings/invoices were current, accurate, and complete.

13. The Contractor has adequate internal budgetary controls.

14. The Contractor was oriented toward the customer while performing the contract/BPA/call order.

15. The Contractor managed subcontractors, subcontract costs effectively and took corrective action to preclude subcontract problems from impacting overall prime contractor performance.

16. The Contractor provided qualified personnel to match the requirements in the contract/BPA/call order.

17. The Contractor has complied with all contract regulatory requirements.

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

Based on the contractor’s overall performance, would you award this contractor another similar contract?

YES

NO

Please provide any additional comments below:

Note to Agency Completing Reference – Please complete this form and return to Lindsay.Hrybyk@ssa.gov, no later than 12:00 pm EDT on Tuesday, December 4, 2018. Thank you for your participation.