Attachment 004 - Past Performance Questionnaire.docx
DOCX document 56 KB Posted
- Attached to
- Accident and Sickness Program for Exchanges (ASPE) Health Benefits Plan Program Federal contract opportunity
- Solicitation number
- 19AQMM25R0153
About this file
This document is a Past Performance Questionnaire designed for contractors to provide detailed performance evaluations for a federal contract. The form comprehensively assesses contractor performance across multiple dimensions, including contract performance, technical performance, management performance, price/cost management, and overall customer satisfaction. The rating scale ranges from "Unsatisfactory" to "Exceptional", with specific evaluation criteria for each rating level.
The questionnaire requires detailed ratings and comments on key performance areas such as adherence to contract schedules, problem-solving capabilities, resource commitment, technical performance, software product delivery, defect resolution, subcontractor management, personnel qualification, cost estimate compliance, and overall customer satisfaction. The form is to be completed by a Contacting Officer, Contacting Officer's Representative, or a corporate official with direct knowledge of the project, and is to be submitted directly to Jeannie Mays at maysjr@state.gov, with instructions not to return the form to the contractor.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 19AQMM25R0153 Amendment 0001.pdf | ||
| 19AQMM25R0153.pdf | ||
| Attachment 002 - Pricing Table.xlsx | XLSX spreadsheet | |
| 19AQMM25R0153.pdf | ||
| Attachment 003 - Quality Assurance Surveillance Plan (QASP).docx | DOCX document | |
| Attachment 001 - Statement of Work (SOW).docx | DOCX document | |
| Attachment 005 - Data Requirements and Misc Notes.xlsx | XLSX spreadsheet |
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Text version
Attachment J Past Performance Questionnaire
NOTE: For each Past Performance Contract Profile submitted, the Offeror must submit this Attachment.
PAST PERFORMANCE PROJECT IDENTIFICATION (To be filled out by the Offeror):
Offeror Name:
Contract Number:
Order Number (if applicable):
Project Title:
Total Period of Performance, Including Options: MM/YYYY - MM/YYYY or MM/YYYY - Present
PAST PERFORMANCE REFERENCE INFORMATION (To be filled out by the Rater):
Name:
Title:
Agency or Customer Organization:
Phone:
E-mail:
Signature of Rater[footnoteRef:1]: [1: ]
Any questions concerning completion of this form should be addressed to maysjr@state.gov.
I. Contractor Evaluation Rating Guidelines It is essential that the individual providing reference information for a contractor understand the rating scale and the criteria for assigning a particular rating to a contractor’s performance. In general, the evaluation questions ask how well a contractor performed on an aspect of the contract. The performance rating scale has a normal range from “Unsatisfactory” to “Exceptional”. The ratings and general guidelines for their use are described below.
· Unsatisfactory - Due to substandard performance, non-conformance to requirements, or non-responsiveness, the contractor has been unable to achieve contract requirements despite the additional use of significant customer resources.
· Poor - Due to marginal performance, partial non-conformance to requirements, or occasional non-responsiveness, the contractor has required significant additional customer resources to be able to meet contract requirements.
· Fair - The contractor has been able to meet contract requirements with only minor additional customer resources, performed at a generally adequate level, and has been somewhat responsive to the customer.
· Good - With only minor exceptions, the contractor has generally met all contract requirements, performed up to expectations, and been responsive to the customer.
· Excellent - The contractor has met all contract requirements, met all performance expectations, and has been consistently responsive to the customer.
· Exceptional - The contractor has gone beyond contract requirements to add value to the customer and performed in an exemplary manner.
| A. | Contract Performance | ||||
| 1. | Did the contractor adhere to the contract sprint/delivery schedule(s)? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 2. | Was the contractor able to solve contract performance problems without extensive guidance from your organization? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 3. | Did the contractor commit adequate resources in a timely fashion to meet contract requirements and successfully solve problems? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 4. | Did the contractor respond positively and promptly to technical direction, contract change orders, etc.? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| B. | Termination History | ||
| 1. | Has the contractor been partially or completely terminated under this contract for default or for the convenience of your organization? | ||
| No | ( ) | ||
| Yes, for convenience | ( ) | ||
| Yes, for default | ( ) |
If yes, please explain reasons for termination (e.g., inability to meet performance requirements): ______________________________________________________________________
| 2. | Are there any pending termination actions? | |
| No | ( ) | |
| Yes | ( ) |
If yes, please explain reasons and describe the status of the action: ______________________________________________________________________
C. Technical Performance
| 1. | Did the contractor consistently deliver software products that met program objectives? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 2. | Did the contractor consistently deliver relatively defect-free software code? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 3. | Did the contractor resolve software defects in a timely manner? | ||||
| Exceptional | ( ) | ||||
| Excellent | ( ) | ||||
| Good | ( ) | ||||
| Fair | ( ) | ||||
| Poor | ( ) | ||||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 4. | Did the contractor consistently meet or exceed performance metrics? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Please describe the specific performance criteria and how they were measured: ______________________________________________________________________
| D. | Management Performance | |||
| 1. | Has the contractor been effective in managing its subcontractors? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 2. | Has the contractor committed adequate financial resources to meet contractual requirements? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 3. | Apart from technical requirements, has the contractor fulfilled all contract terms and conditions? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| 4. | Did the contractor (and its subcontractors) assign qualified personnel to key management functions (e.g., project manager) for executing the contract? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| E. | Price/Cost Management | |||
| 1. | Did the contractor meet its proposed cost estimates? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
| F. | Customer Satisfaction | |||
| 1. | Was your organization satisfied with the contractor’s performance? | |||
| Exceptional | ( ) | |||
| Excellent | ( ) | |||
| Good | ( ) | |||
| Fair | ( ) | |||
| Poor | ( ) | |||
| Unsatisfactory | ( ) |
Comments: ____________________________________________________________
G. Additional Comments Please provide below any additional information not covered in the specific questions in sections A through F that may assist the government in evaluating the contractor’s performance.
Information provided by:
| ___________________ | ________________ | |
| Name | Contact email/phone |
| ____________________ | ________________ | |
| Signature | Date |
Please send Past Performance Questionnaire directly to: Jeannie Mays, maysjr@state.gov
Please do not return to the contractor. Thank you for your response!
Past Performance Rating must be provided by a Contracting Officer, Contracting Officer’s Representative, Contracting Officer’s Technical Representative or Corporate Officer/Official with knowledge about the project.
SBU - CONTRACTING AND ACQUISITIONS
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