AG-3198-S-16-166P_-_Attachment_II_-__PAST_PERFORMANCE_QUESTIONNAIRE.docx

AG-3198-S-16-166P

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-16-166P

The contractor listed below is being considered in a Source Selection by the Food and Nutrition Service, Contract Management Division, 3101 Park Center Drive. It would be appreciated if you would provide us with comments regarding the contractor'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: Linda Mullen at linda.mullen@fns.usda.gov and Sean Merritt at sean.merritt@fns.usda.gov. Any questions regarding this matter, please contact Linda Mullen at (703) 305-2256.

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.

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?

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?

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.