Attachment 0010 Past Performance Questionnaire.docx

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor:____________________ Contract No.:____________________________ Subcontract No. (if applicable):_________________________________ POC:________________________ Title:________________________ (Name) (E.G. PCO/ACO/TM) (Agency, Telephone No., E-mail Address & Fax Number)

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please return the completed Questionnaire within 15 days after receipt. Thank you.

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) A. Compliance of Products, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship.

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

Comments:

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

· Exceptional (Explanation must be provided in Comments field below)

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

C. Timeliness of Performance for Product Deliverables, including the Administrative Aspects of Performance.

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

D. Effectiveness in Forecasting and Controlling Project Cost.

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

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

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

F. Overall Satisfaction.

F. Overall Satisfaction

· Extremely Satisfactory (Explanation must be provided in Comments field below)

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

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

H. 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:

I. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contracting Officer identified in the cover letter.

Thank you for your assistance.