PAST_PERFORMANCE_QUESTIONNAIRE.docx

REQUEST FOR PROPOSAL AG-3198-S-15-0091ATTACHMENT III

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-15-0091

The offeror 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 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 offeror nor discuss your comments on this questionnaire with any other individuals.

This form shall be sent via e-mailed to: Joseph Hodges, email to joseph.hodges@fns.usda.gov. Any questions regarding this matter, please contact Joseph Hodges at (703) 305-2683.

Past Project Information:

1. Offeror 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:_____________ Name of Evaluator Agency or Company:_______________________________ Phone Number:__________________Fax Number:________________ Address:________________________________________________________ Position held or function in relation to the project:_______________________ Project scope of work:____________________________________________

RATINGS:

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

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

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

2. The offeror’s on-site management and coordination of subofferors.

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

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

5. The offeror’s quality control.

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

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

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

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

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

11. Has the offeror 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 offeror? If no, please explain.

13. Was the customer satisfied with the end product?

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

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

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

17. OVERALL RATING: ____________

Please provide any additional comments.