Amendment_A0002_Attachment 3 Past Performance Questionnaire.docx

Source Selection Information—See FAR 2.101 and 3.104 PR 2012-1330

70B04C21R00000005

Attachment 3

Past Performance Questionnaire

Attachment 3: Past Performance Questionnaire

PART ONE: INSTRUCTIONS

The company who has provided you with this form is proposing on a U.S. Customs and Border Protection (CBP) solicitation 70B04C21R00000005, under PR2012-1330. 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 Sonya.L.Freeman@cbp.dhs.gov and Eva Shaw-Taylor@cbp.dhs.gov. This information will not be disclosed to the Offeror. Please provide an honest assessment and return the questionnaire to CBP, by email, to addresses shown below, no later than due date of proposals. If you have questions, please contact:

Sonya.L.Freeman@cbp.dhs.gov and eva.shaw-taylor@cbp.dhs.gov.

Completed questionnaires are to be emailed to the following addressees: Sonya.L.Freeman@cbp.dhs.gov and eva.shaw-taylor@cbp.dhs.gov

PART TWO: GENERAL INFORMATION

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

3. CONTRACT NUMBER: 2a. EVALUATOR

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

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

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:

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

D

TEAMING ARRANGEMENTS

GENERAL TOPICS

Did the contractor comply with 508 requirements?

(when applicable)

C

(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