Attachment 3 - Past Performance Questionnaire (Ombuds).pdf

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Attached to
Organizational Ombuds Service Federal contract opportunity
Solicitation number
93310022Q0016
Issued by
Federal Mediation and Conciliation Service

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File Type Posted
Attachment 2 - Evaluation Criteria_Submission Instructions.pdf PDF
93310022Q0016 Combo Synopsis_Solicitation.pdf PDF
Attachment 1 - Statement of Work.pdf PDF

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PAST PERFORMANCE QUESTIONNAIRE

CONTRACT/PROJECT INFORMATION (To Be Completed by Contractor)

1. Contractor Being Rated:

2. Client Name:

Point of Contact:

Phone Number:

Email:

3. Contract/Project Name:

Contract Number (if applicable):

Period of Performance:

Brief Description:

PLEASE SELECT THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE

1. Quality of work 8. Honest

2. Timeliness of work 9. Trustworthy

3. Resourcefulness 10. Leadership Mindset

4. Interpersonal skills 11. Coachable

5. Job knowledge 12. Authentic

6. Dependability 13. Resilient

7. Flexibility 14. OVERALL RATING

15. Would you select this contractor again?

Any additional comments related to the contractor’s performance/character:

Name/Title of Person Completing the Form Signature Date

Release of Information: This Contractor Performance Report may be used to support future award decisions and will be treated as source selection information in accordance with FAR 3.104-4(k)(1)(x) and 42.1503(b). The completed report shall not be released to other than Government personnel and the contractor whose performance is being evaluated during the period the information is being used to provide source selection information.

Contractor Being Rated:
Client Name:
Point of Contact:
Phone Number:
Email:
Contract Name:
Contract Number:
Period of Performance:
Brief Description:
Additional Comments:
Person Completing the Form:
Date:
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