Attachment 0012 -- Past Performance Questionnaire.docx

Attachment 0012: Appendix A:

Past Performance Evaluation Form

For all contracts identified, a Past Performance Questionnaire, Attachment 0012, must be completed and submitted.

The Offeror shall complete Part I of the Past Performance Questionnaire and e-mail the questionnaire to both the Government contracting activity and technical representative responsible for the past/current contract. The POCs shall be instructed to electronically complete Part II of the questionnaire and e-mail the entire questionnaire to the Contracting Office no later than the proposal due date, to megan.k.frost2.civ@mail.mil and molly.j.lewis4.civ@mail.mil.

The Offeror shall e-mail to the Contracting Officer a list of all the POCs who were sent a questionnaire. The Government must receive this list no later than the proposal due date.

The POC List shall be submitted in Word for Windows Table Format and include the following fields: Solicitation Number; Company Name; Contract Number; Government Agency; POC Last Name, First Name; POC Title; POC Telephone Number; POC E-mail Address; and Date E-Mailed to POC (month/day)

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: Address: E-mail Address:

SOURCE SELECTION INFORMATION (SEE FAR 3.104)

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

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

· Good

· Acceptable

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

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

Comments:

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

· Acceptable

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

C. Timeliness of Performance for Services and Product Deliverables.

· Acceptable

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

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

· Acceptable

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

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

· Acceptable

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

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

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:

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 via e-mail to the Contracting Officer identified in the cover letter (see PART I, page 1, for additional information).

Thank you for your assistance.

Signature Date

Typed or Printed Name