02.02.01 Proposal Attachment 2 - Past Performance Questionnaire - CORRECTED.DOCX
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- Attached to
- 70FBR426Q00000010 | DR4899-MS RFQ - Level II Armed Guard Services Federal contract opportunity
- Solicitation number
- 70FBR426Q00000010
- Issued by
- Federal Emergency Management Agency
About this file
This file is a Contract Performance Customer Questionnaire template designed for past performance reference evaluations in support of FEMA contract opportunities. The questionnaire is used by government agencies and companies to assess contractor performance on previous contracts and should be completed by customers or contracting officers who have direct experience with the contractor being evaluated. Responses are treated as source selection sensitive information and should be submitted directly to the Contract Specialist, in this case Ashlee Young, FEMA Contracting Officer, at (202) 826-5994 or ashlee.young@fema.dhs.gov.
The questionnaire evaluates contractor performance across three primary rating categories: Quality of Service (including compliance with contract requirements, technical excellence, and budget performance), Timeliness of Delivery (including interim milestones, reliability, and schedule achievement), and Overall Customer Satisfaction (including effective management, correspondence, responsiveness, and flexibility). Each category uses a five-point rating scale of Unsatisfactory, Poor, Fair, Good, or Excellent, with detailed guidance provided for each rating level. The form also requires basic contract information such as contractor name, solicitation/contract number, contract type (Firm Fixed Price, Cost Reimbursement, or Other), period of performance, contract value, and a narrative description of the contracted services. Additionally, the questionnaire asks whether the customer would select the contractor again and provides space for supporting comments and explanations.
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Text version
Section J Attachment # Page 1of 2
Contract Performance Customer Questionnaire
1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information and will be sent directly to the Contract Specialist. This information is not to be released to the offeror. Completed questionnaires may be emailed to:
ATTN: Ashlee Young, Contracting Officer DHS/Federal Emergency Management Agency Phone: (202) 826-5994| Email: ashlee.young@fema.dhs.gov
2. Please complete:
Company/Contractor Requesting Reference
Agency/Company Name Providing Reference
Company/Contractor Name
Agency/Company Name
Point of Contact Name
Point of Contact Name
Phone #
POC E-mail / Phone #
E-mail address
Period of Performance
Fax Number
Supply/Service Provided
PAST PERFORMANCE RATING GUIDELINES
Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Poor, Fair, Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”
N/A - NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.
| Ratings |
| Quality of Service |
-Compliance w/contract requirements -Technical excellence -Within budget -Relationship of negotiated costs to actual Timeliness of Delivery -Met interim milestones -Reliable -Delivery Schedule achieved Overall Customer Satisfaction -Effective Management -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable/cooperative -Flexible -Pro-active
| Unsatisfactory |
| Nonconformances |
are comprising the achievement of contract requirements
| Delays are compromising achievement of contract requirements |
| Response is not effective |
| Poor |
| Nonconformances |
require major agency resources to ensure achievement of contract requirements
| Delays require major agency resources to ensure achievement of contract requirements |
| Response is marginally effective |
| Fair |
| Nonconformances require minor agency resources to ensure achievement of contract requirements |
| Delays require minor agency resources to ensure achievement of contract requirements |
| Response is somewhat effective |
| Good |
| Nonconformances |
do not impact achievement of contract requirements
| Delays do not impact achievement of contract requirements |
| Response is usually effective |
| Excellent |
| There are no quality problems |
| There are no delays |
| Response is effective |
PAST PERFORMANCE QUESTIONNAIRE
| 1. Company/Contractor Being Referenced: |
| 2. Solicitation/Contract Number: |
| 3. Address: | |
| 4. Contract Type: | |
| |_| | Firm Fixed Price |
| |_| | Cost Reimbursement |
| |_| | Other (Please Specify) |
| 5. Agency/Company Completing Reference: |
| 6. Agency/Company POC, Phone & Fax: |
7. Period of Performance:
8. Overall Contract Value: $
9. Title of Contract:
10. Description of Contract Service:
11. Complexity of Work: Difficult: |_| Routine: |_|
NOTE: Please use adjectival ratings from attached sheet.
| 12. Evaluation Factor |
| 13. Rating |
| 13. Comments (Attach additional sheets, if necessary.) |
a. Quality of Service
b. Timeliness of Delivery
c. Overall Customer Satisfaction
15. Would you select this company/contractor again? Please explain. (Attach additional sheet if necessary.)
16. Name & Date:
17. Title:
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