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Attachment 17: Past Performance Relevant Experience Form (Document Verification)
Part 1: Project Identification (To be filled out by the Offeror)
| Offeror Name: |
| Click here to enter text. |
| Contractor Name if other than Offeror (Restricted Pool Only): |
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| Contract Number: |
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| Order Number (if applicable) |
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| Project Title: |
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| Short Project Description |
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| Prime or Subcontractor: |
| Choose an item. |
| Contract Type: |
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| Period of Performance (PoP): |
| MM/YYYY – MM/YYYY or MM/YYYY - Present. |
| PoP if all options are exercised: |
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| Obligated Amount: |
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| Base and All Options Value (Total Contract Value): |
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| NAICS: |
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| PSC Code |
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Part 2: Past Performance Reference Information
(a) Contracting Officer (or Corporate Official for Commercial Experience)
| Name: |
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| Title: |
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| Agency or Customer: |
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| Phone: |
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| Email: |
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| Verification Method – |
Choose One
| ☐ | CPAR Attached |
| ☐ | Signature by Contracting Officer or Corporate Official certifies accuracy of ratings in Part 3 | |
| ☐ | Signature by Contracting Officer’s Representative or Federal Program Manager certifies accuracy of ratings in Part 3 – complete Section (b) | |
| Date: Click here to enter a date. |
| Signature of Assessing Official (Contracting Officer or Corporate Official): |
(b) Contracting Officer’s Representative (COR)/Federal Program Manager (FPM) (Complete only if COR/FPM providing signature verification)
| Name: |
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| Title : |
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| Agency: |
| Click here to enter text. |
| Phone: |
| Click here to enter text. |
| Email: |
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| Date: Click here to enter a date. |
| Signature of Assessing Official (COR/FPM): |
Part 3: Evaluation Areas (To be filled out by the Assessing Official)
(a) Quality of Service
Rating
Definition
| ☐ | Exceptional |
| Performance meets contractual requirements and exceeds 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 meets contractual requirements and exceeds 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 was effective. | |
| ☐ | Satisfactory |
| 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. | |
| ☐ | Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. | |
| ☐ | 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. | |
☐ Not Applicable
Additional Comments:
Click here to enter text.
(b) Schedule
Rating
Definition
| ☐ | Exceptional |
| Performance meets contractual requirements and exceeds 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 meets contractual requirements and exceeds 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 was effective. | |
| ☐ | Satisfactory |
| 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. | |
| ☐ | Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. | |
| ☐ | 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. | |
☐ Not Applicable
(c) Cost Control
Rating
Definition
| ☐ | Exceptional |
| Performance meets contractual requirements and exceeds 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 meets contractual requirements and exceeds 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 was effective. | |
| ☐ | Satisfactory |
| 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. | |
| ☐ | Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. | |
| ☐ | 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. | |
☐ Not Applicable
(d) Management of Key Personnel
Rating
Definition
| ☐ | Exceptional |
| Performance meets contractual requirements and exceeds 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 meets contractual requirements and exceeds 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 was effective. | |
| ☐ | Satisfactory |
| 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. | |
| ☐ | Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. | |
| ☐ | 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. | |
☐ Not Applicable
(e) Small Business Utilization
Rating
Definition
| ☐ | Exceptional |
| Exceeded all statutory goals or goals as negotiated. Had exceptional success with initiatives to assist, promote, and utilize small business (SB), small disadvantaged business (SDB), women-owned small business (WOSB), HUBZone small business, veteran-owned small business (VOSB) and service disabled veteran owned small business (SDVOSB). Complied with FAR 52.219-8, Utilization of Small Business Concerns. Exceeded any other small business participation requirements incorporated in the contract/order, including the use of small businesses in mission critical aspects of the program. Went above and beyond the required elements of the subcontracting plan and other small business requirements of the contract/order. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner. | |
| ☐ | Very Good |
| Met all of the statutory goals or goals as negotiated. Had significant success with initiatives to assist, promote and utilize SB, SDB, WOSB, HUBZone, VOSB, and SDVOSB. Complied with FAR 52.219-8, Utilization of Small Business Concerns. Met or exceeded any other small business participation requirements incorporated in the contract/order, including the use of small businesses in mission critical aspects of the program. Endeavored to go above and beyond the required elements of the subcontracting plan. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner. | |
| ☐ | Satisfactory |
| Met all of the statutory goals or goals as negotiated. Had significant success with initiatives to assist, promote and utilize SB, SDB, WOSB, HUBZone, VOSB, and SDVOSB. Complied with FAR 52.219-8, Utilization of Small Business Concerns. Met or exceeded any other small business participation requirements incorporated in the contract/order, including the use of small businesses in mission critical aspects of the program. Endeavored to go above and beyond the required elements of the subcontracting plan. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner. | |
| ☐ | Marginal |
| Deficient in meeting key subcontracting plan elements. Deficient in complying with FAR 52.219-8, Utilization of Small Business Concerns, and any other small business participation requirements in the contract/order. Did not submit Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate or timely manner. Failed to satisfy one or more requirements of a corrective action plan currently in place; however, does show an interest in bringing performance to a satisfactory level and has demonstrated a commitment to apply the necessary resources to do so. Required a corrective action plan. | |
| ☐ | Unsatisfactory |
| Deficient in meeting key subcontracting plan elements. Deficient in complying with FAR 52.219-8, Utilization of Small Business Concerns, and any other small business participation requirements in the contract/order. Did not submit Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate or timely manner. Failed to satisfy one or more requirements of a corrective action plan currently in place; however, does show an interest in bringing performance to a satisfactory level and has demonstrated a commitment to apply the necessary resources to do so. Required a corrective action plan. | |
☐ Not Applicable