Attachment 3 - Past Performance Questionnaire.pdf

Solicitation Number: FA441722Q0020

Attachment 03 Page 1 of 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: __________________ Telephone Number: _____________________

Address: __________________________ Fax Number: __________________________

__________________________ Point of Contact: _______________________

(The government enters the following information based on list of references provided by the offeror.

The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: ____________________________________*

Contract Number Provided by Offeror: _________________________________*

Contract Period or Dates of Performance Provided by Offeror:__________________________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: ___________________ Title: _________________________________

Address: ____________________________ Telephone Number: ___________________

___________________________________ Fax Number: ________________________

___________________________________ Email Address: _______________________

Attachment 03 Page 2 of 3

C. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and

N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A

NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Provided effective quality control and/or inspection procedures to meet contract requirements.

4 Provided timely resolution of contract discrepancies.

5 Provided adequate project supervision.

Attachment 03 Page 3 of 3

The contractor: E G S M U N

Provided accurate and complete line item cost proposals including all aspects of work required for each task.

7 How would you rate the contractor's overall performance?

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

Would you award another contract to this contractor? If not, explain in

“remarks.”

YES/NO

10 Is the contractor rated in CPARS? YES/NO

CONTRACTOR’S NAME: ______________________________________________________________

Remarks:_____________________________________________________________________________