9Q0TDBNS006_Past-Performance-Questionnaire.doc

SOURCE SELECTION INFORMATION – SEE FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

I. CONTRACT IDENTIFICATION

Contractor Name:

Contract Number:

II. EVALUATOR INFORMATION

Name:

Phone Number:

Organization:

Relation to Program:

(Contracting Officer, COR, etc.)

III. TERMINATION HISTORY

1. Has this contract been partially or completely terminated for default or convenience?

( ) Yes

( ) Default ( ) Convenience ( ) No

If yes, explain (e.g., inability to meet cost, performance, or delivery schedules).

2. Are there any pending terminations?

( ) Yes ( ) No

If yes, explain and indicate the status.

IV. EVALUATION

(Please CIRCLE or UNDERLINE the rating which best describes the Contractor’s performance for each of the following questions and provide a narrative explanation in the “Comments” area that supports your choice. If the question does not apply, circle or underline “N/A” for “Not Applicable.”) Below is a description of each rating.

E – EXCEPTIONAL – Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V – VERY GOOD – Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S – SATISFACTORY – Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M – MARGINAL – Performance does not meet all contractual requirements. The contractual performance of the element or sub-element being assessed reflects serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

U – UNSATISFACTORY – Performance does not meet contractual performance and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problems for which the contractor’s corrective actions appear or were ineffective.

N/A - NOT APPLICABLE

Your narrative statements are important. Please provide a narrative for each area no matter how brief. Please attach additional pages if there is insufficient space in the comment space.

1. Quality of Product/Service (e.g., equipment, qualified personnel, quality control): does the contractor meet established guidelines and policies for safety and security? Does the contractor meet industry standards and local building codes for equipment installation?

E V S M U

Comments:

2. Schedule: does the contractor provide adequate staffing to meet workload requirements and is work performed in a timely manner and in accordance with the requirement? Was the job completed on time?

E V S M U

3. Cost Control: was the job completed within the dollar amount for the contract? Was the contractor amendable to making changes in a cost-effective manner and reasonable in negotiating the value of the work?

S M U

4. Business Relations: are contractor personnel promoting a strong working relationship with the Government? Does the contractor adequately address and make efforts to resolve issues/problems concerning on-site employees? Does the contractor show initiative? Were contractor personnel courteous and responsive? Did the contractor interface effectively with your staff?

S M U

5. Management of Key Personnel: is the contractor providing the site manager/lead employees with the necessary resources and support to adequately perform their work? Does the contractor adequately address and make efforts to resolve issue/problems concerning the site manager/lead employees? Is the contractor able to solve contract performance problems without extensive guidance from Government counterparts?

S M U

Comments:

6. Please comment on any other contractor information you consider relevant to this evaluation.

Comments:

9Q0TDBNS006

SOURCE SELECTION INFORMATION – SEE FAR 3.104

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9Q0TDBNS006