Attachment 25 Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION

a. Contractor: ________________________________________

b. Contract Number: ________________________________________

c. Type of Contract: (check all that apply)

i. ( ) Negotiated ( ) Sealed Bidding

ii. ( ) Competitive ( ) Non-Competitive

iii. ( ) Firm-Fixed-Price ( ) Cost-Plus-Fixed-Fee

( ) Time-and-Materials ( ) Labor Hour ( ) Indefinite Quantity ( ) Requirements Other: __________________________________

d. Please complete the following:

Period of Performance: _________________ to ___________________ Initial Contract Value: $_____________________ Current (or Completed) Contract Value $_____________________

e. Brief description of requirement:

f. Complexity of effort: ( ) Difficult ( ) Routine

Please provide the following information (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Name of Evaluator: _________________________________ (Customer Contact) Telephone Number: __________________________________ Facsimile Number: __________________________________ Organization/Office Symbol: ________________________ Mailing Address: ___________________________________

Position Title/Grade: ______________________________ Thank you in advance for completing this survey. THIS INFORMATION WILL

BE PROTECTED IN ACCORDANCE WITH FAR 15.1004(e).

SCORING CRITERIA

EXCEPTIONAL - Indicates the Contractor’s performance within the area of evaluation clearly and consistently exceeds contractual requirements.

ACCEPTABLE - Indicates no problems in area of evaluation or has only minor problems for which solutions were satisfactory.

MARGINAL - Indicates major agency resources to ensure achievement of contract requirements.

UNACCEPTABLE - Indicates serious problems in the evaluation area. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur.

I. QUALITY OF SERVICE

_____ Exceptional _____ Acceptable ____Marginal _____ Unacceptable Narrative:

II. TIMELINESS OF PERFORMANCE

_____ Exceptional _____ Acceptable ____Marginal _____ Unacceptable Narrative:

III. PRICE/COST CONTROL

_____ Exceptional _____ Acceptable ____Marginal _____ Unacceptable Narrative:

IV. BUSINESS RELATIONS (Ability to effectively manage contract.)

_____ Exceptional _____ Acceptable ____Marginal _____ Unacceptable Narrative:

V. CUSTOMER SATISFACTION

_____ Exceptional _____ Acceptable ____Marginal _____ Unacceptable Narrative:

BASED ON THIS CONTRACTOR’S OVERALL PERFORMANCE, WOULD YOU

AWARD THIS CONTRACTOR ANOTHER CONTRACT? YES NO

If no, please explain: _______________________________________

PLEASE USE THE SPACE BELOW TO PROVIDE ANY ADDITIONAL COMMENTS

CONCERNING THE PAST PERFORMANCE OF THE CONTRACTOR:

Survey Completion Date: ____________________________

Thank you for completing this past performance evaluation.