Attachment 0005 - Past Performance Questionnaire.docx

W912CH-24-R-0086

Attachment 0005 Past Performance Questionnaire

1. GENERAL INSTRUCTIONS:

This information, when filled in, shall be treated as Source Selection Sensitive in accordance with FAR 3.104-3 and shall not be disclosed to anyone outside the Government Source Selection Team.

Upon completion of this questionnaire, please forward it by electronic mail to: Mr. Mark Hilson, mark.d.hilson.civ@army.mil

2. Description Of The Current Solicitation:

The U.S. ACC in Detroit Arsenal, MI proposes to release a solicitation W912CH-24-R-0086 for the Sight Reflex, NSN: 1240-01-576-6134

3. Instructions on Completing Questionnaire:

Offerors interested in proposing on this effort have been requested to send the provided Past Performance Questionnaire to the appropriate point(s) of contact on past and present contracts, which the offeror deems relevant to this effort as defined in Section L. In this regard, the United States Army is conducting a past performance assessment in anticipation of a possible contract award.

We are requesting your assistance in completing this questionnaire so that we may evaluate the offerors in the area of past performance. This questionnaire has been developed for ease of electronic completion. Please provide your comments regarding the overall assessment of the contractor’s performance on the contract identified. Any additional information, which your organization deems relevant or important, will be welcome by our evaluation team. If a question on the questionnaire is Not Applicable or no significant or meaningful contract performance has not taken place (Too soon to tell), please so indicate.

SUSPENSE: Please complete and submit the questionnaire as soon as possible, but it is requested no later than the Request for Proposal (RFP) closing date of 5:00 PM Local Time, Warren, MI on 01 October 2026. Thank you in advance for your assistance in making this a Best Value Trade Off Procurement.

Past Performance Assessment Questionnaire Please provide your candid response to the following questions. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual and accurate as possible. If you do not have the appropriate knowledge with the company in question, please forward this questionnaire to the person who does. Upon completion of this questionnaire, please forward by electronic email to POC at Mr. Mark Hilson, mark.d.hilson.civ@army.mil by 01 October 2026. Thank you for your assistance.

PART I - IDENTIFICATION

To be completed by the Offeror

A. RELEVANT CONTRACT

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract/Task Order Number:

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

Contract Award Date:

Contract Period of Performance End Date:

Forecasted or Actual Contract Completion:

Brief Description of the Relevant Contract Scope:

B. OFFEROR’S REPRESENTATIVE

Company Name:

Business Address:

Name:

Title:

E-mail Address:

Telephone Number:

PART II - EVALUATION

To be completed by Point of Contact – Respondent

RATING SCALE & DEFINITIONS

Table 1 identifies the rating scale and descriptions. Please apply the rating that most closely matches your assessment for each area of consideration listed below. Please include a written narrative for each rating applied, utilizing the adjectival rating definition in Table 1.

Table 1

Once filled in, this document is considered Source Selection Information – See FAR 2.101 and FAR 3.104

1. Quality:

Assess the quality of the contractors’ deliverables in accordance with the contract terms and conditions. This includes the following (as applicable): product performance, product assurance/quality control, standards of good workmanship.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Too soon to tell Not Applicable Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor.

2. Management / Business Relations:

Assess the management and business relations during Contract performance. This includes (as applicable): completeness and quality of problem identification, timeliness of corrective action plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior, customer satisfaction, and management of subcontracts.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Too soon to tell Not Applicable Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. delays by the customer/end user, changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor (e.g. unusually severe weather or default of a subcontractor beyond the control of both the Contractor and subcontractor).

3. Schedule Assess the timeliness of the contractor against the delivery schedule. Please include the contractor’s efforts that contributed, negatively or positively, to the delivery schedule. Please provide in the comments section if any Delivery extensions were granted, and why the extensions were needed (i.e. the extent of the fault of the contractor).

Exceptional Very Good Satisfactory Marginal Unsatisfactory Too soon to tell Not Applicable Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. delays by the customer/end user, changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor (e.g. unusually severe weather or default of a subcontractor beyond the control of both the Contractor and subcontractor).

4. Regulatory Compliance To the best of your knowledge, did the contractor comply with regulatory requirements? This includes compliance with financial, environmental, safety, and labor regulations as well as any other regulatory requirements in the contract terms and conditions.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Too soon to tell Not Applicable Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. delays by the customer/end user, changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor (e.g. unusually severe weather or default of a subcontractor beyond the control of both the Contractor and subcontractor).

5. General Comments.

Any additional information, which your organization deems relevant or important, will be welcome by our evaluation team. Please provide any other relevant or important performance information.

Comments:

6. RESPONDENT IDENTIFICATION

Please provide respondent point of contact information who compiled or completed Part II of this questionnaire and who, if needed, may be contacted by our evaluation team regarding the information provided in this questionnaire. NOTE: Send completed questionnaire to the Point of Contact identified on Page 1.

Name:

Title:

Date:

E-mail Address:

Telephone Number:

Company Name:

Business Address:

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