Attachment 3 Past Perfromance Questionnaire RFP.docx

Attachment 3

PAST PERFORMANCE QUESTIONNAIRE

70RCSA20R00000016

Completed questionnaire should be e-mailed to Tiffany Kindred-Lopez & Kerri B. Williams at the Department of Homeland Security (DHS), Office of Procurement Operations (OPO). Email address: tiffany.kindredlopez@hq.dhs.gov & kerri.williams@hq.dhs.gov

When complete, this form is SOURCE SELECTION INFORMATION in accordance with FAR 3.104 and must be protected accordingly.

1. Company Name: ___________________________________________________________________

Name of Company this survey pertain to: _____________________________________________________

2. Place of Performance: ___________________________________________________________________

3. Telephone No.: ________________ 4. Fax No.: ________________ 5. E-mail: ___________________

6. CAGE Code: __________________ 7. DUNS+4 No.: ____________ 8. Contract No.: ______________

8a. Identify whether the effort under the contract listed in item 8 is/was the prime or subcontracted effort:

11. If the amounts for 9 and 10 above are different, provide a brief description of the reason:_________________

12. Award Date: _________ 13. Original Completion Date: _________ 14. Current Completion Date _______

15. Primary cause of change in completion date, if original and current dates are different:

16. Type of Contract: ____________________ 17. Federal Supply Code (FSC) _____________________

18. North American Industry Classification (NAIC) Code ____________

20. Key Subcontractor(s): Company Name: _________________________________________

Work Performed: _________________________________________________________________________

Primary Points of Contact:

29. Administrative Contracting Officer: ____________________________ 30. Telephone No.;_____________

31. Fax No.___________________________ 32. E-mail:_______________________________

Background information for person completing this survey:

33. Name:____________________________________ 34. Title:_________________________________

35. Organization:___________________________ 36. Phone (commercial)____________ 37. Fax:____________

38. Email address:_____________________________________

39. Dates of involvement with contract/program: From:_______________ to:__________________

40. Period of performance being assessed for this survey:__________________________________

PAST PERFORMANCE EVALUATION

Please use the following Assessment Rating System. "A fundamental principle for rating is that contractors shall not be assessed below a rating of satisfactory for not performing beyond the requirement of the contract." Circle the letter(s) corresponding to your rating and provide a narrative rationale to support the report card assessment rating and help determine relevancy in support of the source selection. If more space is required, you may use the back of this questionnaire, or you may request an electronic copy of this document (Word). Hand written responses are also sufficient.

Assessment Rating System

Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets contractual requirements and exceeds some of the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.

Satisfactory 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 appear or were satisfactory.

Marginal 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. The Contractor’s proposed actions appear only marginal effective or were not fully implemented.

Contractor’s corrective actions appear or were ineffective.

Neutral No past performance/experience available. Proposal receives no merits or demerit for this factor.

A. Quality of Product/Service: This area relates to contractor’s compliance with contract requirements, to include providing appropriate personnel and technical excellence.

4. Identification, surveillance, and management of major/ E VG S M U N/A critical subcontractors. ________________________________________________________________________

6. Adequacy of maintaining and controlling Government E VG S M U N/A property. ____________________________________ _______________________________________________

B. Timeliness of Performance: This is the areas that relates to the contractor’s ability to meet milestones and delivery schedule, to include responsiveness to technical direction, completion of efforts on time including wrap-up and contract administration.

9. Overall performance in planning, schedule, and E VG S M U N/A monitoring. (Note causes of any schedule variances)

11. Responsiveness to technical contract changes, E VG S M U N/A from a contract administration perspective.

C. Management of Key Personnel:

15. Assess the contractor's performance in selecting, retaining, E VG S M U N/A supporting, and replacing, when necessary, key personnel. _______________________________________

D. Cost Control:

of such efficiency are shared with the Government.

part to ( ) Government issued change orders ( ) claims submitted by the contractor ( ) other Government actions ( ) other contractor actions.

25. Based on the Contractor’s overall performance, would you award this Contractor another Government contract? Yes _______________ No ____________ (if no, please explain).

SOURCE SELECTION SENSITIVE – SEE FAR 3.104

SOURCE SELECTION SENSITIVE