Appendix D Past Performance Questionnaire.pdf

APPENDIX D

Performance Assessment

411th CONTRACTING SUPPORT BRIGADE, KOREA

UNIT 15289

APO AP 96271-5590

Humphreys Contracting Division XX XXXX 2023

Humphreys Contracting Division, 411th CSB, Korea

Subject: Offeror Past Performance Assessment in Support of Request for Proposal Number

W91QVN23R0016

Dear Sir/Ma'am;

The 411th Contracting Support Brigade is currently conducting a competitive source selection to evaluate Offerors on subject RFP W91QVN23R0016. As part of this evaluation, we have requested that the Offerors provide information about their past performance on same or similar federal, state or local government or commercial contracts as compared to North American Industry Classification System (NAICS) 7223310, Food Service, Cafeteria. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to the 411th CSB, Humphreys Contracting, Team A, Emery S. Moser and Jamika D. Mullen, no later than seven (7) days after receipt of this request. Your questionnaire may be submitted electronically to emery.s.moser.civ@army.mil or jamika.d.mullen.civ@army.mil. Your cooperation is greatly appreciated. Questions may be directed to Emery S Moser, Contract Specialist, (0503) 355-3403 or the undersigned at (0503) 355-3340.

Sincerely, JAMIKA D. MULLEN

Contracting Officer mailto:emery.s.moser.civ@army.mil mailto:jamika.d.mullen.civ@army.mil

Performance Assessment Questionnaire

Contractor: ____________________ Contract No.:____________________________ Subcontract No. (If applicable):_________________________________

POC: ________________________ Title: ________________________ (Name) (E.G. PCO/ACO/TM) (Agency, Telephone No., E-mail & Facsimile No.)

The following questions pertain to the contractor's record of past performance (within the past seven years) and current performance. The information that you provide will be used in the award of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following ratings shall be used in your response.

Rating Definitions:

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

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

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: rationale is required for each response.

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

� Acceptable � Unacceptable (Explanation must be provided in Comments field below)

Comments:

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

� Acceptable � Unacceptable (Explanation must be provided in Comments field below)

Comments:

C. Timeliness of Performance for Services and Product Deliverables.

� Acceptable � Unacceptable (Explanation must be provided in Comments field below)

Comments:

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

� Acceptable � Unacceptable (Explanation must be provided in Comments field below)

Comments:

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

� Acceptable � Unacceptable (Explanation must be provided in Comments field below)

Comments:

F. General Comments. Provide any other relevant performance information.

Comments: _________________________________________________________ G. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

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

Point of Contact (Name): __________________________________________ Telephone Number: ______________________________________________

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter.

Thank you for your assistance.