Attachment 04 - Past Performance Questionnaire.doc

70CMSW22Q00000004

RFQ Attachment 4 Past Performance Questionnaire

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

When filled in this document is source selection sensitive iaw FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: ____________________________________________________________________

B. Contract number: _______________________________________

C. Contract type: ______________________________

D. Was this a competitive contract? Yes _____ No _____

E. Period of performance: _________________________________________________________

F. Initial contract cost: $____________________________

G. Current/final contract cost: $_______________________________

H. Reasons for differences between initial contract cost and final contract costs:

I. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name and title: ____________________________________________________________________ B. Evaluator's phone/fax number: __________________________________________________________________

C. Number of years evaluator worked on subject contract: _____________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE

PERFORMANCE LEVEL

O OUTSTANDING - The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example to others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as “Excellent”.

E EXCELLENT – The contractor has substantially exceeded the contract performance requirements.

G GOOD – There are no, or very minimal issues and the contractor has met the contract requirements.

F FAIR – Overall compliance requires minor agency resources to ensure achievement of contract requirements.

P POOR – Overall compliance requires significant agency resources to ensure achievement of contract requirements.

U UNSATISFACTORY – Non-conformances are jeopardizing the achievement of contract requirements, despite use of agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

N

NOT APPLICABLE - Unable to provide a score.

Ability to understand/comply with customer objectives and technical requirements

Effectiveness of assigned personnel in terms of the appropriate mix of education and experience to accomplish the requirement.

Adequacy/effectiveness of quality control program

Quality/effectiveness of sub-contracted efforts

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

Ability to successfully respond to emergency and/or surge situations

Effectiveness of material management (including Government Furnished Property or Material)

Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

Contractor ability to smoothly transition resources and personnel.

Contractor effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

Ability to hire/apply a qualified workforce to this effort.

Ability to retain a qualified workforce on this effort.

Accuracy in forecasting contract costs

Ability to meet forecasted costs and perform within contract costs

Ability to alert Government of unforeseen costs before they occur

Sufficiency and timeliness of cost reporting

Government Contracts Only: has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___

No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

What were the contractor’s greatest strengths in the performance of the contract?

What were the contractor’s greatest weaknesses in the performance of the contract?

Would you hire this contractor in the future to perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature

Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Email Address: Daniel.M.Correia@ice.dhs.gov