Attachment 3 - Past Performance Questionnaire.docx

ATTACHMENT 3: PAST PERFORMANCE QUESTIONNAIRE

PART I (TO BE COMPLETED BY OFFEROR REQUESTING THE REFERENCE)

A. OFFEROR INFORMATION

Offeror Name:

Offeror Address:

B. CONTRACT IDENTIFICATION

Project Title:

Contract Number:

Agency/Customer:

Agency/Customer POC Name:

Agency/Customer POC Email Address

Contract/Order/Subcontract/Other:

Contract Type:

Contract Purpose (e.g., Service, Supply, Deveopment/First Article, R&D)?

Contract Award Date:

Period of Performance

Total Contract Value:

Value of Offeror’s Share

Was the Offeror a Prime Contractor?

Yes

No

Was the Offeror a Sub Contractor?

Yes

No

Competitive Award?

Yes

No

Program Title and nature of the effort (i.e., describe the scope of the effort, the type of tasks involved, labor skills used, and products/support delivered).

PART II (TO BE COMPLETED BY RESPONDENT)

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support very high or very low rating should be noted on page 5.

Assign each area a rating of, 4 (Outstanding), 3 (Good), 2 (Satisfactory), and 1 (Unsatisfactory). Use the attached Rating Guidelines which is provided as Exhibit 1 as guidance in making these evaluations. Circle the appropriate rating.

A. IDENTIFICATION OF RESPONDENT

Name:

Title:

Telephone Number:

Address:

Email:

B. EVALUATION

QUALITY OF SERVICE:

TIMELINESS OF PERFORMANCE:

COST CONTROL:

PROGRAM MANAGEMENT:

CUSTOMER RELATIONSHIP:

OVERALL CUSTOMER SATISFACTION:

ADDITIONAL COMMENTS:

If rated below a 3, please provide additional comments below to justify rating(s).