Attachment 3 - P.Perform Survey VOHSS 12082022.xlsx
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- Solicitation number
- 19AQMM23R0017
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Past Performance Survey
| 19AQMM23R0017 | ||
| PAST PERFORMANCE SURVEY | ||
| Introduction: The United States Department of State (DOS) is currently conducting a competitive procurement for items and/or services described in this solicitation for which the prospective offeror [insert offeror nameXXXXX] has been requested to identify customers with whom it is currently or has been recently under contract, to serve as potential references on its past performance record. You are being asked to complete the attached Contractor Past Performance Survey. You may also be contacted by a DOS procurement official to arrange a telephone interview, using the survey as the focal point of the interview. To ensure frank and open evaluations and expressions of opinions by evaluators, all parties are advised that the identity of respondents completing the survey will be held in confidence and will not be released or disclosed to the prospective offeror or outside the Government. | ||
| Instructions: Please complete all areas of this form indicated in light yellow. | ||
| PART I - CONTRACT INFORMATION | ||
| a. Contractor: | XXXXX | |
| b. Customer Name (Federal Agency or Other): | ||
| c. Technical Point of Contact Information | ||
| i. Name: | ||
| ii. Telephone Number: | ||
| iii. Facsimile Number: | ||
| iv. E-mail Address: | ||
| v. Mailing Address: | ||
| vi. Position Title/Grade: | ||
| d. Contract Number: | ||
| e. Type of Contract | (Select responses from drop down menu) | |
| i. Negotiated or Sealed Bidding: | Negotiated | |
| ii. Competitive or Non-Competitive: | Competitive | |
| iii. Firm-Fixed-Price, Cost-Plus, Time-and-Materials/Labor Hour, Hybrid, or Other: | Firm-Fixed-Price | |
| iv. Indefinite Quantity, Requirements, or neither: | Indefinite Quantity | |
| f. Contract Period of Performance: |
| h. Initial Contract Value: $ |
| i. Current (or Completed) Contract Value: $ |
| j. Brief Description of the Contract Requirement: |
(Include a summary of the scope and complexity of the services provided.)
| PART II - GOVERNMENT PAST PERFORMANCE/CUSTOMER SATISFACTION EVALUATION |
| EVALUATION RATINGS |
| EXCELLENT: Indicates the Contractor's performance within the area of evaluation clearly and consistently exceed contractual requirements. |
| SATISFACTORY: Indicates the Contractor's performance within the area of evaluation met the contractual requirements. |
| MARGINAL: Indicates the Contractor's performance within the area of evaluation experienced minor problems for which solutions were satisfactory. |
| UNACCEPTABLE: Indicates the Contractor's performance within the area of evaluation experienced serious problems. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur. |
| EVALUATION AREA 1: Quality of product or service, including consistency in meeting goals and targets | |
| (Select the rating that applies from drop down menu) | |
| Overall ability to proactively and effectively perform contract requirements: | |
| Overall quality of products and services delivered: | |
| Project/performance goals and objectives are consistently achieved: | |
| EVALUATION AREA 2: Cost control, including forecasting costs as well as accuracy in financial reporting | |
| (Select the rating that applies from drop down menu) | |
| Overall quality, completeness, and accuracy of price/cost proposals/invoices: | |
| Ability to perform within negotiated costs/prices: | |
| Ability to provide innovative solutions that resulted in cost savings: | |
| EVALUATION AREA 3: Schedule, including the timeliness against the completion of the contract, milestones, delivery schedules, and administrative requirements | |
| (Select the rating that applies from drop down menu) | |
| Overall quality of performance in planning, scheduling, and monitoring: | |
| Completion of major milestones on schedule: | |
| Timely completion of efforts within period of performance: | |
| EVALUATION AREA 4: Commitment to Customer Satisfaction and Business Like Concern for the Interest of its Customers | |
| (Select the rating that applies from drop down menu) | |
| Performance demonstrates concern for meeting customer's objectives: | |
| Seeks to provide services that meets customer's expectations: | |
| Demonstrates a commitment to provide quality customer service: | |
| COMMENTS (Please include any additional comments concerning the past performance of the contractor): |
Thank You for completing this past performance evaluation. Please email the completed survey to the following address:
Richmondqj@state.gov
&P
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