A04 - Past Performance Questionnaire.pdf

COMPETITION SENSITIVE

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104

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VIII. APPENDIX C – PAST PERFORMANCE QUESTIONNAIRE

SUBJECT: Past Performance Questionnaire

MEMORANDUM FOR:

1. The Project Manager, Soldier Warrior, Fort Belvoir, VA, through its contracting agency, US Army Contracting Command - Aberdeen Proving Ground, APG, MD, is acquiring Next Generation Hubs in support of the NW system to fulfill its mission.

2. Offerors interested in proposing on this work have been requested to send the attached Past Performance Questionnaire to points of contact on past and present contracts, which the offeror deems relevant to this effort. In this regard, the US Army is conducting a past performance assessment in anticipation of a possible contract award.

3. We are requesting your assistance in completing this questionnaire so that we may evaluate the offerors in the areas of experience and past performance. The attached questionnaire has been developed for ease of electronic completion. Please provide your comments regarding the overall assessment of the contractor’s performance on the contract identified. Any additional information, which your organization deems relevant or important, will be welcome by our evaluation team. If a question on the questionnaire is not applicable, please so indicate.

4. Please complete and submit the questionnaire within five (5) days of receipt via E-mail to michael.f.siwek.civ@mail.mil. If you have any questions relative to the enclosed questionnaire, please contact me.

4. Thank you in advance for your assistance.

Sincerely, Samantha L. Degele Contracting Officer

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Next Generation Hub (NGH) Past Performance Questionnaire

Please provide your candid response to the following questions. The information that you provide will be used in the awarding of federal contracts. Therefore it is important that your information be as factual and accurate as possible. If you do not have the appropriate knowledge of or experience with the company in question, please forward this questionnaire to the person who does. Please return within 5 days.

Thank you.

PART I.(To be Completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (To be Completed by Point of Contact – Respondent)

A. Technical Quality of Products, Documents, Presentations, and Related Deliverables

Excellent (Significantly Exceeds Expectations) Good (Exceeds Expectations) Adequate (Meets Expectations) Poor (Significantly Below Expectation, Provide comment in field below) Unknown (N/A)

Comments:

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B. Effectiveness of Project Management (to include use and control of subcontractors).

Adequate (Meets Expectations)

C. Timeliness of Performance for Services and Product Deliverables.

Adequate (Meets Expectations)

D. Overall Satisfaction.

Good (Exceeds Expectations) Adequate (Meets Expectations)

E. General Comments.

F. Other Information Sources Please provide the following information:

G. Are you aware of other relevant past efforts by this company with your agency/company?

If yes, please provide the name, telephone number and email of a point of contact.

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H. Respondent Identification: Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

PART III. Return Information

Please return this completed questionnaire via e-mail to Name: Michael F. Siwek Email address: michael.f.siwek.civ@mail.mil Telephone Number: (410) 278-3876

Thank you for your assistance.