Past_Performance_Survey_Attachment_II_6-23-2015.pdf

SOURCE SELECTION INFORMATION - / FOR OFFICIAL USE ONLY

-1-

Attachment II

OFFEROR’S PAST PERFORMANCE

THIS FORM IS PROVIDED FOR THE PURPOSE OF PROVIDING TO

AND SUBMITTAL BY THE OFFEROR’S REFERENCES

PAST PERFORMANCE QUESTIONNAIRE FOR

SOLICITATION NUMBER#: AG-3198-S-15-0041

The contractor listed below is being considered in a Source Selection by the Food and Nutrition, Contract Management Division, 3101 Park Center Drive, Suite 228. It would be appreciated if you would provide us with comments regarding the contractor's past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal

Acquisition Regulation (15.1004) prohibits the release of the names of individuals providing reference information about an Offeror’s past performance. In order to maintain the integrity of the source selection process, respectfully request that you do not divulge the name of the contractor nor discuss your comments on this questionnaire with any other individuals.

This form shall be Emailed to: Kevin Alexander at kevin.alexander@fns.usda.gov and Thu Vo at

Thu.Vo@usda.fns.gov. Any questions regarding this matter, please contact Kevin Alexander at

(703) 756-0232 and Thu Vo at (703) 605-4717.

Past Project Information:

1. Contractor name and address:

2. Project Title and/or Contract Number:

Evaluator (The following information will assist in the analysis of the data. Information will be kept confidential.)

Name of Evaluator:______________________________Date:_____________

Phone Number:__________________Fax Number:________________

Address:________________________________________________________

Position held or function in relation to the project:_______________________

RATINGS:

Please evaluate the contractor’s performance using the following ratings:

“E” Exceptional – The contractor’s performance greatly exceeded the stated requirements.

“HA” Highly Acceptable – The contractor’s performance exceeded the stated requirements.

“A” Acceptable – The contractor’s performance met the stated requirements.

“M” Marginal – The contractor’s performance met the stated requirements, but with difficulty.

“U” Unacceptable – The contractor’s performance did not meet the stated requirements.

mailto:kevin.alexander@fns.usda.gov mailto:Thu.Vo@usda.fns.gov

-2-

Please rate and provide any supporting information for the following: (Use additional sheets as necessary)

1. The relationship between the contractor and the customer’s contract team.

2. The contractor’s on-site management and coordination of subcontractors.

3. The contractor’s overall corporate management, integrity, reasonableness and cooperative conduct.

4. The contractor provided competent program/project manager, supervisor, and workers

5. The contractor’s quality control.

6. The contractor’s ability to meet the performance schedule.

7. The contractor took measures to improve his schedule problems, if any?

-3-

8. The contractor’s ability to provide the required work at a reasonable price.

9. The contractor’s compliance with laws, regulations, and policies, if applicable.

10. The contractor rectified identified problems in a timely fashion without further incident of the same.

11. Has the contractor been given any of the following: Cure notice; show cause, letters of reprimand, suspension of payments, termination? If yes, please explain.

12. Would you award another contract to this contractor? If no, please explain.

13. Was the customer satisfied with the end product?

-4-

14. Was the contractor provided an opportunity to discuss any negative performance ratings? If so, what were the results?

15. The contractor maintained a professional working relationship with Government personnel.

16. The contractor was reasonable and cooperative in resolving customer complaints.

17. OVERALL RATING: ____________

Please provide any additional comments.