Attachment_G_-_Past_Performance_Questionnaire.docx
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STB Case Management System
DTOS5918R00000
PAST PERFORMANCE QUESTIONNAIRE
Source Selection Sensitive (when completed)
OFFEROR/TEAM:____________________________________________________________________
1. REFERENCE INFORMATION FOR:
Contractor:
Contract Number:
| Type of Contract: | ||
| ( ) Fixed Price Type | ( ) Cost-Reimbursement Type | ( ) Other: |
Period of Performance:
| Contract Value: |
| (initial) $ |
(current)..$
2. CONTACT INFORMATION: Please provide the following information for the person(s) providing the reference (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary)
Name of Contact:
Phone & Fax Numbers:
Organization/Office:
Position Title/Grade:
Period of involvement in contract:
Status of Contract/Project
Questionnaire Completion Date:
PAST PERFORMANCE QUESTIONAIRE
For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment lines may be used to provide any additional information deemed noteworthy).
High
Low
QUALITY OF SERVICE/SOLUTION:
Issue Anticipation/Prevention; Process Improvement; Oral and written communications; Thoroughness; Extent to which deliverables were complete and accurate; Overall Quality
NA
Comment:
TIMELINESS OF PERFORMANCE:
Extent to which performance objectives were met on schedule; Extent to which deliverables were provided on time; Extent to which Invoices were submitted on time
PRICE/COST CONTROL:
Performed Within Estimates; Cost Consciousness
CUSTOMER SATISFACTION:
Business/Contracting Relations; Response to Change; Subcontract Management; Interaction with End Users; Extent of End User Satisfaction; Responsiveness; Problem Resolution
High
DATA MIGRATION:
Data migration process; Cost/schedule of migration; Success of data migration effort.
Comments (attach additional pages as necessary):
GENERAL INFORMATION: Please provide answers to the following questions.
6. Has the contractor ever been given a cure notice, show cause notice, suspension of progress payments, or other letters directing the correction of a performance problem; or has this contract been partially or completely terminated, or is there any pending termination actions? ( ) No ( ) Yes
If yes: ( ) Default ( ) Convenience; and please explain:
| 7. | Changes in contract dollar value throughout the life of the contract are/were attributable, for the most part, to: | ||
| ( ) Government-issued change orders | ( ) claims submitted by the contractor | ||
| ( ) other Government actions | ( ) other contractor actions (please explain below) N/A |
| 8. | Based on this contractor’s overall performance, would you award this contractor |
| another Government contract? |
( ) Yes ( ) No If no, please explain:
9. Has the contractor performed any data migrations out of Lotus Notes for your effort? If so, was the migration successful?
( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain:
10. If any of the above responses are based on adverse past performance, have you discussed it with the contractor and has the contractor had an opportunity to comment?
( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain:
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