47QMCA25R0004_PastPerfQuestionnaire.pdf

PAST PERFORMANCE REFERENCE QUESTIONNAIRE

Form Instructions: The Offeror must complete Part I – Reference Information then provide the questionnaire to the reference Point of Contact (Respondent) who should then complete Part II

– Respondent Information.

The completed questionnaire must be submitted by the Offeror as instructed in the solicitation.

Part I – Reference Information (To be completed by Offeror)

A. Offeror Information:

Contractor’s Name:

Address:

Point of Contract (POC):

POC Phone:

POC Email:

B. Project Title and Brief Description

C. Contract Data

Contract No.: Delivery/Task Order No.:

POC Name & Title:

POC Phone No.: POC Email:

Contract Type:

Contract Dollar Value (base + option periods):

Contract Period of Performance (base + option periods):

Contractor Performed as: Prime Sub-Contractor

Part II – Respondent Information (To be completed by Reference POC)

Instructions to Reference/Respondent:

Please complete Part II – Respondent Information of this form providing past performance information as it relates to Part I – Reference information provided by the Offeror.

A. Reference/Respondent Information

Name & Title of Respondent:

Organization:

Phone No.: Email:

Respondent’s role in relation to the contract (e.g., program/project manager (PM/PjM), contracting officer (CO/KO), major end user, etc.):

Please identify any information known to be inaccurate as provided by the Offeror in Part I.

B. Rating Definitions:

Using the adjectival rating table below, choose the appropriate letter in response to performance questions on page 3 that most accurately describes the contractor’s performance or situation.

Rating Definition

Exceptional Performance met contractual requirements and exceeded many to the government’s benefit.

The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance met contractual requirements and exceeded some to the government’s benefit.

The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance met contractual requirements. The contractual performance of the element or sub-element being evaluated contained some minor problems for which corrective actions taken by the contractor appeared to be or were satisfactory.

Marginal Performance did not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflected a serious problem for which the contractor did not identify corrective actions. The contractor’s proposed actions were only marginally effective or were not fully implemented.

Unsatisfactory Performance did not meet most contractual requirements and recovery was not accomplished in a timely manner. The contractual performance of the element or sub-element contained a serious problem(s) for which the contractor’s corrective actions were ineffective.

C. Performance Questions

When responding to the questions below select the appropriate rating from the drop-down list using the definitions in the Rating Definition table above.

Contractor Performance Respondent Ratings

1. How would you rate the quality of the contractor’s services provided?

2. How would you rate the contractor’s reliability and timeliness of the services delivered?

3. How would you rate the contractor’s ability to effectively manage the work (e.g., organization, personnel, communication, quality control)?

4. How would you rate the contractor’s business relations in terms of support (e.g., cooperative and proactive behavior, flexibility)?

5. How would you rate the contractor’s ability to identify and resolve problems in a timely and effective manner?

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

7. How would you rate the contractor’s performance on small business subcontracting?

8. How would you rate your overall satisfaction with the contractor’s performance?

D. Additional Narrative Justification

If required, insert additional supporting narrative, referencing the number of the contractor performance question it applies to; additional pages may be used. If none, insert “Not applicable.”

E. Signature of Respondent

Signature: