D-5 Past Performance Questionnaire.doc
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- Automatic Door Preventative Maintenance
- Solicitation number
- 28321320Q00000032
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Social Security Administration
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Text version
28321320Q00000032
Social Security Administration
CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE
28321313Q00000032 Thank you in advance for taking time to fill out this questionnaire for the Social Security Administration (SSA). The purpose of this questionnaire is to obtain information regarding the quality of the named contractor’s (Quoter) past performance relative to a contract (completed or in progress) at your agency or company.
General Instructions:
1. The Quoter shall complete Box 1 on Page 2.
2. The Government Contracting Officer (or Corporate Official) shall complete the rest of this questionnaire.
3. SSA requests that the Government Contracting Officer (or Corporate Official) submit this completed Questionnaire directly to Jeremiah.Quijote@ssa.gov, no later than 2:30 PM EST on December 9, 2019.
General Information
1. Quoter Completes the Yellow Sections Below
Contractor (Quoter) Name:
Contractor’s (Quoter’s) E-Mail address and Contact Information:
Contract Number:
Project Title:
Contract/Project Period of Performance (fill in date contract began, and anticipated completion date):
2. Reference Company/Agency Completes the Blue Sections Below
Agency/Company:
Name of Person Completing this Questionnaire:
Email address of Person Completing this Questionnaire:
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
Adjectival Ratings and Definitions
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:
| Rating |
| Definition |
| Note |
Exceptional
(E)
| 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. |
| To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
Very Good
(VG)
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 To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified.
Satisfactory
(S)
| 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 |
| To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order |
Marginal
(M)
| 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. |
| To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter). |
Unsatisfactory
(U)
| 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. |
| To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters). |
Not Applicable
(N/A)
| No performance information is available. |
| Rating will be neither positive nor negative |
Rating Questions Instructions: Please check the applicable box using the Rating Key on Page 3 of this Questionnaire. Provide additional comments to substantiate the assigned rating in the empty box below your rating.
1. Quality of Service
| E |
| VG |
| S |
| M |
| U |
| N/A |
(a) The contractor provided a product or service that Conformed to contract requirements, specifications, and standards of good workmanship.
(b) The contractor provided an effective quality control plan/program.
(c) The Contractor utilized Personnel that were properly trained and experienced.
(d) How would you rate the contractor’s commitment to customer satisfaction?
Please provide comments to substantiate the assigned rating. At a minimum, provide comments to substantiate any rating that is checked Exception (E), Very Good (VG), Marginal (M), Unsatisfactory (U), or Not Applicable (N/A).
2. Timeliness of Performance
| E |
| VG |
| S |
| M |
| U |
| N/A |
(a) The contractor was reliable and responsive to technical direction.
(b) Contract deliverables were completed and provided timely and in accordance with contract schedules.
(c) The contractor adhered to contract schedule, there were no deductions taken for timeliness issues.
Please provide comments to substantiate the assigned rating. At a minimum, provide comments to substantiate any rating that is checked Exception (E), Very Good (VG), Marginal (M), Unsatisfactory (U), or Not Applicable (N/A).
3. Business Relations
| E |
| VG |
| S |
| M |
| U |
| N/A |
(a) The contractor demonstrated effective and efficient management.
(b) The contractor cooperated with the government in providing flexible, proactive, and effective solutions to issues.
(c) The contractor promptly notified the government in a timely manner regarding urgent issues.
(d) The contractor was successful in recruiting and maintaining qualified and reliable personnel.
(e) The product/services adequately met the needs of the government, and I am satisfied with the performance of the contractor under this effort.
Please provide comments to substantiate the assigned rating. At a minimum, provide comments to substantiate any rating that is checked Exception (E), Very Good (VG), Marginal (M), Unsatisfactory (U), or Not Applicable (N/A).
4. Management of Key Personnel
| E |
| VG |
| S |
| M |
| U |
| N/A |
(a) 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?
| Yes |
| No |
| N/A |
(b) If a key person did not perform well, was action taken by the contractor to correct this?
(c) If a replacement of a key person was necessary, did the replacement meet or exceed the qualifications of the position as described in the contract schedule?
Please provide comments to substantiate the assigned rating. At a minimum, provide comments to substantiate any rating that is checked Exception (E), Very Good (VG), Marginal (M), Unsatisfactory (U), or Not Applicable (N/A).
5. Overall Performance
| E |
| VG |
| S |
| M |
| U |
| N/A |
(a) How would you rate the Contractor’s overall performance on this effort?
| Yes |
| No |
(b) Based on the contractor’s overall performance, would you award this contractor another similar contract?
Please provide any additional comments below:
Thank you for your participation!
Source Selection Information – See FAR 2.101 and 3.104
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