36C78618R0094-00002002.docx

NCA PAST PERFORMANCE QUESTIONNAIRE

Name/Address of Contractor

Company Name: Click here to enter text.

Division Name: Click here to enter text.

Address: Click here to enter text.

Click here to enter text.

Work Performance Contract Percent Complete: Click here to enter text.

Contract information Contract Number: Click here to enter text.

Contracting Agency: Click here to enter text.

Responsible Officer: Click here to enter text.

Phone Number: Click here to enter text.

Location of Work: Click here to enter text.

Award Date: date Effective Date: date Completion Date: date Estimated/Actual Completion Date: date Awarded Value: $Click here to enter text.

Current Contract Dollar Value: $Click here to enter text.

Key Subcontractors and Effort Performed

1. Name __________________________________

2. Name __________________________________

3. Name __________________________________

4. Name __________________________________

5. Name __________________________________

Contract Effort Description: Click here to enter text.

Small Business Utilization (%): Click here to enter text.

Assessing Official Comments:

Additional/Other:

Click here to enter text.

Recommendation:

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Name and Title of Assessing Official:

Name: Click here to enter text.

Title: Click here to enter text.

Organization: Click here to enter text.

Phone Number: xxx-xxx-xxxx Email Address: Click here to enter text.

Date: date

ADJECTIVE RATING GUIDE

Rating Definition Note

(E) Exceptional

Performance meets contractual requirements and exceeds many to the Government/Owner’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.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. 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.

(VG) Very Good

Performance meets contractual requirements and exceeds some to the Government /Owner’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.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory

Performance meets minimum 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.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) 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.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) 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 serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable

No information or did not apply to your contract Ra Rating will be neither positive nor negative.