36C24419R0102-004.docx

CONTRACTOR’S NAME: CONTRACT NUMBER

ATTACHMENT - B

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: Telephone Number: Address:

Fax Number:

Point of Contact:

Project Title and Brief Description of Work:

Contract Period or Dates of Performance Provided by Offeror:

Contractor performed as the 0 Prime Contractor 0 Sub-Contractor 0 Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address:

Telephone Number: Fax Number:

Email Address:

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

contractor’s proposed actions appear only marginally effective or were not fully implemented ineffective.

CONTRACTOR’S NAME: CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

supervisors commensurate with contract requirements.

problems.

procedures to meet contract requirements.

proposals including all aspects of work required for each task.

performance?

Remarks:

Note: While these questions are generic and will work as written in many acquisitions, consider them as they relate to each individual acquisition and tailor them as needed and appropriate. Also, when tailoring the form, consider leaving space between questions for comments.