Attachement 3 - Past Performance Questionnaire.pdf
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- Attached to
- FDIC Acquisition System Next Generation (AS-NG)
- Solicitation number
- 0167
- Issued by
-
Federal Deposit Insurance Corporation
About this file
This is the Federal Deposit Insurance Corporation (FDIC) Past Performance Questionnaire form (FDIC 3700/57), a template used to collect contractor performance evaluations from government agencies and commercial organizations that have done business with prospective offerors.
The questionnaire is designed to be completed by references familiar with a contractor's past performance and submitted directly to the FDIC Contracting Officer. It requires respondents to rate contractor performance across six core evaluation areas using a six-point coding scale: Exceptional (E), Very Good (V), Satisfactory (S), Marginal (M), Unsatisfactory (U), and Not Applicable (N). The evaluation criteria address Cost/Price Control (ability to deliver at agreed-to prices), Schedule Adherence (timeliness of deliverables and reports), Performance (compliance with contract requirements and quality assurance standards), Quality (adherence to quality standards and service delivery), and Business Relations (contractor cooperation, personnel stability, and responsiveness). Additional questions request an overall performance rating, identification of contractor strengths and weaknesses, likelihood of future award, and awareness of similar contract efforts performed by the contractor. The form requires respondent information including name, title, organization, telephone number, and email address. The estimated reporting burden is 45 minutes per response. OMB control number 3064-0072 is valid through June 30, 2028.
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Other files
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| Attachment 2 - AS-NG Pricing Workbook 06252026.xlsx | XLSX spreadsheet | |
| Attachment 1 AS-NG Q and A Responses 06172026.xlsx | XLSX spreadsheet | |
| Attachment 1 AS-NG Q and A Responses 06172026.xlsx | XLSX spreadsheet | |
| CORHQ-26-R-0167-Amendment 1 - AS NG Solicitation 6172026.pdf | ||
| Attachment 2 - AS-NG Pricing Workbook 05262026.xlsx | XLSX spreadsheet | |
| Attachment 2 - AS-NG Pricing Workbook.xlsx | XLSX spreadsheet | |
| Attachment 1 - AS NG Q and A Template.xlsx | XLSX spreadsheet | |
| CORHQ-26-R-0167 -- AS NG Soliciation 05222026.pdf |
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Text version
OMB Number: 3064-0072 Expiration Date: 06/30/2028
Page 1 of 6FDIC 3700/57 (10-24)
Federal Deposit Insurance Corporation
PAST PERFORMANCE QUESTIONNAIRE
ESTIMATED REPORTING BURDEN
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Paperwork Reduction Act Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, N.W., and to the Office of Management and Budget, Paperwork Reduction Project (3064-0072), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a collection unless it displays a currently valid OBM control number.
Page down to access form FDIC 3700/57
Page 2 of 6FDIC 3700/57 (10-24)
TO: Government agency or commercial organization (i.e., customer) with knowledge of offeror's past performance.
I. Please complete sections IV and V of this questionnaire, which relates to the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the Federal Deposit Insurance Corporation (FDIC). Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided FDIC with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to FDIC relative to their past performance, whether it is positive or negative information.
Email the completed questionnaire to the attention of the responsible FDIC Contracting Officer. Your completed questionnaire must be provided directly to the FDIC Contracting Officer from you. FDIC will not accept completed questionnaires sent from the offeror.
The offeror must complete sections I and II below prior to providing your with the questionnaire, or provide you with the information to fill in.
FDIC Solicitation Number:
* ATTN: Contracting Officer:
* Email Address:
* Offeror must obtain this information from the solicitation and/or the Contracting Officer.
II. Information of the contract/award for which the past performance assessment is being requested:
A. Contractor:
B. Contract Number:
C. Government agency/commercial organization:
D. Period of Performance:
E. Total Contract Amount (including any options):
F. Describe Good(s) and/or Service(s) Acquired:
III. Explanation of Codes:
CODE PERFORMANCE LEVEL
E EXCEPTIONAL - Performance meets contractual requirements and exceeds many (requirements). The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
V VERY GOOD - Performance meets contractual requirement and exceeds some (requirements).
The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Page 3 of 6FDIC 3700/57 (10-24)
CODE PERFORMANCE LEVEL
S SATISFACTORY - Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
M MARGINAL - Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
U UNSATISFACTORY - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
N NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.
IV. Using the codes above, please select the appropriate letter for each item on the questionnaire and provide supportive narrative.
1. COST/PRICE CONTROL
Rate the contractor's ability to control cost and deliver at the agreed-to price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).
E V S M U N
2. SCHEDULE ADHERENCE
How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?
E V S M U N
Page 4 of 6FDIC 3700/57 (10-24)
Rate the contractor's ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.
E V S M U N
3. PERFORMANCE
How well did the contractor adhere to the requirements of a Quality Assurance Plan or Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?
E V S M U N
4. QUALITY
E V S M U N
Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor's responsiveness to managing changes in providing replacement personnel.
5. BUSINESS RELATIONS
Page 5 of 6FDIC 3700/57 (10-24)
E V S M U N
6. What is your overall rating of the contractor's performance?
7. Identify the contractor's strengths.
8. Identify the contractor's weaknesses.
9. Given the choice, would you award to this contractor again? Why?
Page 6 of 6FDIC 3700/57 (10-24)
10. Are you aware of any other efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
V. Please provide the information below of the person completing this questionnaire.
A. Name of Respondent:
B. Title:
C. Government agency/commercial organization:
D. Telephone Number:
E. Email Address:
Thank you for your assistance.
OMB Number: 3064-0072 Expiration Date: 06/30/2028
Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
OMB Number: 3064-0072 Expiration Date: 06/30/2028 OMB Number: 3064-0072 Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
OMB Number: 3064-0072 Expiration Date: 06/30/2028 OMB Number: 3064-0072 Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
OMB Number: 3064-0072 Expiration Date: 06/30/2028 OMB Number: 3064-0072 Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
OMB Number: 3064-0072 Expiration Date: 06/30/2028 OMB Number: 3064-0072 Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
OMB Number: 3064-0072 Expiration Date: 06/30/2028 OMB Number: 3064-0072 Expiration Date: 06/30/2028
FDIC 3700/57 (10-24)
FDIC 3700/57 (10-24)
Federal Deposit Insurance Corporation
PAST PERFORMANCE QUESTIONNAIRE
Federal Deposit Insurance Corporation
PAST PERFORMANCE QUESTIONNAIRE
ESTIMATED REPORTING BURDEN
ESTIMATED REPORTING BURDEN
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Paperwork Reduction Act Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, N.W., and to the Office of Management and Budget, Paperwork Reduction Project (3064-0072), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a collection unless it displays a currently valid OBM control number.
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and completing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Paperwork Reduction Act Officer, Legal Division, Federal Deposit Insurance Corporation, 550 17th Street, N.W., and to the Office of Management and Budget, Paperwork Reduction Project (3064-0072), Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a collection unless it displays a currently valid OBM control number.
TO: Government agency or commercial organization (i.e., customer) with knowledge of offeror's past performance.
Please complete sections IV and V of this questionnaire, which relates to the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the Federal Deposit Insurance Corporation (FDIC). Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided FDIC with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to FDIC relative to their past performance, whether it is positive or negative information.Email the completed questionnaire to the attention of the responsible FDIC Contracting Officer. Your completed questionnaire must be provided directly to the FDIC Contracting Officer from you. FDIC will not accept completed questionnaires sent from the offeror.
The offeror must complete sections I and II below prior to providing your with the questionnaire, or provide you with the information to fill in.
TO: Government agency or commercial organization (i.e., customer) with knowledge of offeror's past performance.
Please complete sections IV and V of this questionnaire, which relates to the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the Federal Deposit Insurance Corporation (FDIC). Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided FDIC with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to FDIC relative to their past performance, whether it is positive or negative information.
Email the completed questionnaire to the attention of the responsible FDIC Contracting Officer. Your completed questionnaire must be provided directly to the FDIC Contracting Officer from you. FDIC will not accept completed questionnaires sent from the offeror.
The offeror must complete sections I and II below prior to providing your with the questionnaire, or provide you with the information to fill in.
* Offeror must obtain this information from the solicitation and/or the Contracting Officer.
* Offeror must obtain this information from the solicitation and/or the Contracting Officer.
Information of the contract/award for which the past performance assessment is being requested:
2. Information of the contract/award for which the past performance assessment is being requested:
Explanation of Codes:
3. Explanation of Codes:
CODE
CODE
PERFORMANCE LEVEL
PERFORMANCE LEVEL
| E | EXCEPTIONAL - |
| E | EXCEPTIONAL - |
Performance meets contractual requirements and exceeds many (requirements). The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Performance meets contractual requirements and exceeds many (requirements). The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
| V | VERY GOOD - |
| V | VERY GOOD - |
| V | VERY GOOD - |
Performance meets contractual requirement and exceeds some (requirements). The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Performance meets contractual requirement and exceeds some (requirements). The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Performance meets contractual requirement and exceeds some (requirements). The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
| S | SATISFACTORY - |
| S | SATISFACTORY - |
| S | SATISFACTORY - |
Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
| M | MARGINAL - |
| M | MARGINAL - |
| M | MARGINAL - |
Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
U UNSATISFACTORY -
Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.
U UNSATISFACTORY -
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.
| N | NOT APPLICABLE - |
| N | NOT ACCEPTABLE - |
| N | NOT APPLICABLE - |
Unable to provide a score. Performance in this area not applicable to effort assessed.
Unable to provide a score. Performance in this area not applicable to effort assessed.
Unable to provide a score. Performance in this area not applicable to effort assessed.
Using the codes above, please select the appropriate letter for each item on the questionnaire and provide supportive narrative.
4. Using the codes above, please select the appropriate letter for each item on the questionnaire and provide supportive narrative.
COST/PRICE CONTROL
(1) COST/PRICE CONTROL
Rate the contractor's ability to control cost and deliver at the agreed-to price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).
Rate the contractor's ability to control cost and deliver at the agreed-to price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).
SCHEDULE ADHERENCE
(2) SCHEDULE ADHERENCE
How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?
How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?
Rate the contractor's ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.
Rate the contractor's ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.
PERFORMANCE
(3) PERFORMANCE
How well did the contractor adhere to the requirements of a Quality Assurance Plan or Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?
How well did the contractor adhere to the requirements of a Quality Assurance Plan or Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?
QUALITY
(4) QUALITY
Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor's responsiveness to managing changes in providing replacement personnel.
Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor's responsiveness to managing changes in providing replacement personnel.
BUSINESS RELATIONS
(5) BUSINESS RELATIONS
What is your overall rating of the contractor's performance?
(6) What is your overall rating of the contractor's performance?
Identify the contractor's strengths.
(7) Identify the contractor's strengths.
Identify the contractor's weaknesses.
(8) Identify the contractor's weaknesses.
Given the choice, would you award to this contractor again? Why?
(9) Given the choice, would you award to this contractor again? Why?
Are you aware of any other efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
(10) Are you aware of any other efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
Please provide the information below of the person completing this questionnaire.
5. Please provide the information below of the person completing this questionnaire.
Thank you for your assistance.
Thank you for your assistance.
7/1/2021
DOA/ASB
FDIC
FDIC 3700/57, Past Performance Questionnaire
10/30/2024 (AH)
J. David Manion For questions regarding this form, email Forms@fdic.gov.
| FDICSolicitation: |
| ContractingOfficer: |
| EmailAddress: |
| Contractor: |
| ContractNumber: |
| PeriodOfPerformance: |
| TotalContractAmount: |
| DescribeProductAcquired: |
| Q4-1Explanation: |
| : |
| Q4-2Explanation: |
| Q4-3Explanation: |
| Q4-4Explanation: |
| Q4-5Explanation: |
| Q4-6Explanation: |
| Q4-7Explanation: |
| Q4-8Explanation: |
| Q4-9Explanation: |
| Q4-10Explanation: |
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