Attachment_Three_-PAST_PERFORMANCE_QUESTIONNAIRE.pdf

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

The company who has provided you with this form is proposing on a Department of Homeland Security (DHS) solicitation to provide a full range of Radio Frequency Identification (RFID) vehicle transponders to meet the mission needs of DHS. Past Performance is an extremely important part of the evaluation criteria for this acquisition, so your input is very important. The information is to be provided directly to, the DHS Contract Specialist. This information will not be disclosed to the offeror. Please provide an honest assessment and return the questionnaire to DHS, by e-mail, to the address shown below, no later than the time and date the solicitation closes _______________. If you have questions, please contact Lloyd A. Burton, 817-868-8646.

Completed questionnaires should be emailed to the following address: lloyd.a.burton@cbp.dhs.gov.

GENERAL INFORMATION

1. OFFEROR’S NAME AND ADDRESS 2. CUSTOMER ORGANIZATION

3. CONTRACT NUMBER: 2a. EVALUATOR

4. CONTRACT VALUE: _______________________ NAME:

TITLE:

PHONE NO:

5. CONTRACT AWARD DATE: 6. CONTRACT COMPLETION DATE:

7. CONTRACT TYPE (Circle All That Apply): 8. COMPLEXITY OF WORK (Circle One Response):

Fixed Price Cost-Plus Fixed Price Cost-Plus Award Fee DIFFICULT ROUTINE

T & M OTHER

PART TWO: GENERAL INFORMATION CONTINUED

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

SOURCE SELECTION SENSITIVE INFORMATION

PART THREE: OFFEROR PERFORMANCE RATING

On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set of sub factors with four possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this offeror and indicate your assessment by placing an “X” under the appropriate heading. Offeror performance factors are:

A. CORPORATE COMMITMENT

B. QUALITY OF SERVICE

C. TIMELINESS OF PERFORMANCE

D. TEAMING ARRANGEMENTS

Adjectival ratings are defined below and should be used as a reference in assessing performance:

OUTSTANDING Contractors performance significantly exceeded the contract requirements.

GOOD Contractors performance exceeded the contract requirements.

ACCEPTABLE Contractors performance met contract requirements.

UNSATISFACTORY Contractors performance was less than acceptable and was unable to perform contract requirements successfully.

N/A Not applicable.

CORPORATE COMMITMENT Outstanding Good Accept. Unsat. N/A

Did contractor provide effective contract and project management?

Did the contractor provide a systematic approach to provide the most current technologies, services and techniques available in the market place?

How effective has the contractor been in understanding and responding to user requirements?

Did the contractor establish and maintain effective quality control standards and procedures?

QUALITY OF SERVICE Outstanding Good Accept. Unsat. N/A

Did the contractor provide quality goods/services?

Did the contractor provide quality reports and documentation (i.e., accurate, current and complete)?

Was the contractor able to solve contract performance problems without extensive guidance from counterparts?

Did the contractor supply professional and qualified personnel?

Did the contractor respond to emergency situations to include staffing and responsiveness?

TIMELINESS OF PERFORMANCE Outstanding Good Accept. Unsat. N/A

Did the contractor adhere to contract delivery schedules in the following areas:

(a) Performance of services?

(b) Delivery of reports or other documentation?

(c) Qualified Staffing

1. Has this contract been partially or completely terminated for default? YES NO

If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules - also include contract number, name, address, and phone number of Terminating Contracting Officer - TCO).

2. What was the contractor’s greatest strength in the performance of the contract?

3. What was the contractor’s greatest weakness in the performance of the contract?

4. Would you award another contract to this contractor? YES No

COMMENTS:

PART FOUR: EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF

MY KNOWLEDGE.

SIGNATURE OF EVALUATOR

TITLE OF EVALUATOR DATE

TEAMING ARRANGEMENTS Outstanding Good Accept. Unsat. N/A

Did the contractor have an effective partnership with its team members?

What percentage of the contract award work was performed by the team members? (Provide Percentage)

Did the Prime contractor execute a teaming arrangement?

(Circle Y or N)

YES NO

GENERAL TOPICS

Did the contractor deputy EVM? YES NO

Did the contractor comply with 508 requirements?

(when applicable)

YES NO