Rev.1 Attachment 5 - Past Performance Questionnaire.docx

REV.1 ATTACHMENT 5 - PAST PERFORMANCE QUESTIONNAIRE47PL0122R0050

Please complete and submit this reference with your proposal package

Instructions to Offerors

· Section 1 – To be completed by the Contractor

· Section 2 – To be completed by the Reference

Please complete the following questionnaire on behalf of the contractor listed in Section 1. Only the project listed in Section 1 shall be considered for this evaluation. For each question below, select the rating that best describes the Contractor’s performance. Please provide a narrative explanation where appropriate; any narrative comments are greatly appreciated. If the contractor has completed other work for your agency/organization in the last three (3) years, you may note that as additional comments.

Your responses will be reviewed solely for the purposes of a past performance evaluation and no one other than the Government selection committee will see your response.

If you have additional comments to provide, please add them at the end of the attached questionnaire. Thank you, in advance, for your time and providing GSA with this valuable feedback.

47PL0122R0050

PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. CONTRACTOR INFORMATION

Firm Name:

Address:

Phone Number: UEI Number:

Contact Name:

Email Address: Contact Phone Number:

Percent (%) of project work performed:

If a subcontractor, who was the prime (Name/Phone #):

3. CONTRACT INFORMATION

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please explain) Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Original Contract Completion Date (mm/dd/yy): Actual Completion Date (mm/dd/yy):

Explain Schedule Change:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

NOTE: PBS requests that the client complete this Questionnaire and submit it directly back to the offeror. The offeror will submit this completed Questionnaire to PBS with their proposal, and may duplicate this Questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit Questionnaires directly to the offeror. However, Questionnaires may be submitted directly to PBS. Please contact the offeror for PBS POC information. The Government reserves the right to verify any and all information on this form.

47PL0122R0050

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

(U) Unsatisfactory

TO BE COMPLETED BY CLIENT47PL0122R0050

CLIENT INFORMATION

Client Information:

Name:

Title:

Phone Number:

Email Address:

Describe the client’s role in the project:

Date Questionnaire was completed (mm/dd/yy):

Client’s Signature:

Instructions: Please select the adjective rating and the Yes/No reply that best reflects your evaluation of the contractor’s performance.

(a) Quality of technical data/report preparation efforts.

(b) Ability to meet quality standards specified for technical performance.

(c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance.

(d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance).

(a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below.)

(b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract.

(a) To what extent were the end users satisfied with the project?

(b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication).

(c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

(d) Overall customer satisfaction.

(a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

(b) Ability to hire, apply, and retain a qualified workforce to this effort.

(c) Government Property Control.

(d) Knowledge/expertise demonstrated by contractor personnel.

(e) Utilization of Small Business concerns.

(f) Ability to simultaneously manage multiple projects with multiple disciplines.

(g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes.

(h) Effectiveness of overall management (including ability to effectively lead, manage and control the program).

(a) Ability to meet the terms and conditions within the contractually agreed price(s)?

(b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client.

(c) If this is/was a Government cost type contract, or a CMc/CMc at Risk Contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns).

(d) Is the Contractor’s accounting system adequate for management and tracking of costs? (If no, please explain in comment section below.)

Yes

No

(e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? (Indicate if show cause or cure notices were issued, or any default action in comment section below.)

(f) Have there been any indications that the contractor has had any financial problems? (If yes, please explain in the comment section below.)

(a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.).

(b) Contractor complied with all security requirements for the project and personnel security requirements.

7. SUSTAINABILITY

Were sustainability methods, processes, or materials incorporated into the project? (If yes, please explain in the comments section below.)

Yes

No

(a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

(b) Compliance with contractual terms/provisions (If there were specific issues, please explain in the comments sections below.)

(c) Would you hire or work with this firm again? (If no, please explain in the comments section below.)

Yes

No

(d) In summary, provide an overall rating for the work performed by this contractor.

COMMENTS SECTION

Please provide additional information below, and attach additional pages if necessary. 47PL0122R0050

Please provide responses to the above questions (if applicable) and/or additional remarks. Also please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

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