Attachment 3 - Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Source Selection Information – See FAR 3.104 and FAR 2.101

The Department of Homeland Security (DHS), FEMA, recently released a Request for Quote (RFQ) for the procurement of supplies or services RFQ 70FBR724Q00000019. Offerors were asked to provide information on contracts similar in nature, size, and complexity to the present requirement on which they had performed in the past. An offeror has submitted this to you as a reference for past performance. (See blocks 1 to 3 below).

We need your opinion on how well the contractor performed on your contract(s). Please fill out the attached questionnaire and send it electronically to either the Contracting Officer at stewart.knotts@fema.dhs.gov or the Contract Specialist at kimber.russell@fema.dhs.gov. To be considered, this form must be filled out and received by the Contracting Officer no later than the closing date and time listed in the RFQ.

DHS/FEMA may contact you to clarify or verify any information provided. For purposes of confidentiality, only send this completed form to the FEMA Contracting Officer.

Your input will be confidential. Please note your comments will be used to form the basis for evaluation of this offeror. Thank you in advance for your assistance. If you have any questions, please contact the Contracting Officer at stewart.knotts@fema.dhs.gov.

A. CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Block 1. Contractor Name:

Block 2. Contractor phone number and address:

Block 3. Contract Name and Number: |

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE

AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Evaluator’s Printed Name Title

Evaluator’s Mailing Address (Agency, Bldg/Room, Street, City, State, Zip)

Evaluator’s Signature Date Phone Fax

B. INSTRUCTIONS

Two forms are provided to document your opinion: 1) Performance Rating Form; and 2) Supplemental Comment Form. Please fill out both forms in accordance with the instructions provided on each. Please use the following standards in arriving at your rating: Superior, Good, Satisfactory, Marginal, Unsatisfactory, or Neutral.

70FBR724Q00000019 Attachment 3

QUESTIONNAIRE PERFORMANCE RATING FORM (put an X in the appropriate box)

Performance Element Superior Good Satisfactory Marginal Unsatisfactory Neutral

1. STAFFING CAPACITY:

Contractor has demonstrated support capacity that will meet the expected Armed services requirements

2. CUSTOMER SATISFACTION:

The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.

3. RESPONSIVENESS AND

ATTENTIVENESS: The contractor exhibited reasonable and cooperative behavior in response to criticism/rejection of contract deliverables and in immediately correcting errors, poor performance, and other problems.

OVERALL PERFORMANCE:

QUESTIONNAIRE SUPPLEMENTAL COMMENT FORM

Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. We appreciate your time and valuable comments. Please add additional pages as necessary.

Performance Element 1. STAFFING CAPACITY

Performance Element 2. CUSTOMER SATISFACTION

Performance Element 3. RESPONSIVENESS AND ATTENTIVENESS: