ATTACHMENT 5 -- PAST PERFORMANCE INFORMATION SURVEY 3-29-21.docx

PAST PERFORMANCE INFORMATION SURVEY

Please complete the following questionnaire and return via email to felecia.a.beamen@cbp.dhs.gov on or before April 19, 2021 @ 4pm ET

This survey pertains to: ________________________________________________ Department/Component: _______________________________________________ Contract Number: _______________________ Date of Survey: ________________ Name of Person Completing Survey: _____________________________________ Signature of Person Completing Survey: __________________________________ Your Company/Agency: ________________________________________________

Contract Value (including options): $______________________ Performance Period: ___________________________________ (including option periods) Type of Contract: ______________________________________ Approximate percentage of work being performed (or completed) by subcontractor(s): ____________%

Information on subcontractor(s) (where more than __________% of work was completed by the subcontractor):

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Commentary to support rating shall be noted on page 4.

Assign each area a rating of 0 (Unsatisfactory), 1 (Poor), 2 (Fair), 3 (Good), 4 (Excellent), or 5 (Outstanding). Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle "N/A" (not applicable/no opinion).

QUALITY OF SERVICE__________________________________________________

1. Compliance with contract requirements 0 1 2 3 4 5 N/A

2. Accuracy of reports 0 1 2 3 4 5 N/A

3. Effectiveness of personnel 0 1 2 3 4 5 N/A

4. Technical Excellence 0 1 2 3 4 5 N/A

OMB Clearance No. 9000-0142 Source Selection Information

PAST PERFORMANCE INFORMATION SURVEY

TIMELINESS OF PERFORMANCE_________________________________________

1. Met interim milestones 0 1 2 3 4 5 N/A

2. Reliability 0 1 2 3 4 5 N/A

3. Responsive to technical direction 0 1 2 3 4 5 N/A

4. Completed on time including wrap-up and contract administration 0 1 2 3 4 5 N/A

5. Met delivery schedules 0 1 2 3 4 5 N/A

6. Liquidated damages assessed: Yes No (circle one)

BUSINESS RELATIONS_________________________________________________

1. Effective management, including management of subcontracts 0 1 2 3 4 5 N/A

2. Reasonable/cooperative behavior 0 1 2 3 4 5 N/A

3. Responsive to contract requirements 0 1 2 3 4 5 N/A

4. Notification of problems 0 1 2 3 4 5 N/A

5. Flexibility 0 1 2 3 4 5 N/A

6. Pro-active instead of reactive 0 1 2 3 4 5 N/A

CUSTOMER SATISFACTION

1. The contractor is committed to customer satisfaction.

Yes No (circle one)

2. Would you recommend selection of this firm again?

Yes No (circle one)

ADDITIONAL COMMENTS:

RATING GUIDELINES

Billings

-Outstanding: The contractor has demonstrated an outstanding performance level in any of the above four categories that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances when contractor performance clearly exceeds the performance levels described as "Excellent."