Attachment 3 - PastPerfQuestionnaire.pdf

Attachment 3 Name of Contractor:

Solicitation: 19GE5020R0066

FOR OFFICAL USE ONLY

SOURCE SELECTION SENSITIVE (WHEN COMPLETED)

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PAST PERFORMANCE QUESTIONAIRE

1. Background: The US Department of State (DOS) needs your assistance in obtaining information for a current Source Selection. Your input will help us evaluate the past performance of the offeror indicated below. This questionnaire concerns past or current contractors for which you have personal knowledge.

2. Instructions: Please complete this questionnaire based on the following guidance.

Please take the time to answer the questions to the best of your knowledge. Note that due to a standard rating system, some answers may not seem to fit the questions. Circle the responses that best describe the contractor’s performance, and write in a narrative explanation for your answer. Use a N/A rating to indicate that you have no performance information for that particular area, or the question does not apply to you. Each question has space for your comments. If more space is needed, please attach additional sheets to the end of the questionnaire and reference the respective question. Handwritten (ink) responses are sufficient.

We urge you to supplement your own knowledge of the offeror’s performance with the judgement of others in your organization. In addition to completing the attached questionnaire for the identified contract, we solicit your comments on other similar programs for which your office has contracts with this offeror.

Name of Contractor (being evaluated): ____________________________________________

Title/Description of Contract: _____________________________________________________

Based upon the definitions below, indicate your assessment of this contractor’s performance on similar projects performed for your company. Your assessment should consider the contractor’s performance in accordance with the contractual requirements.

Assessment Definition

Satisfactory The contractor performed within expectation, without any problems.

Marginal The contractor’s performance was in accordance with the contract’s requirements, but not without a few problems or issues.

Unsatisfactory The contractor’s performance failed to meet expectations. Recurring problems existed that negatively impacted the organization’s mission.

N/A Not Applicable.

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1. How well did the contractor have understanding of the tasks to be performed on the contract?

Satisfactory Marginal Unsatisfactory N/A Comments: ____________________________________________________________________

2. How well did the contractor identify problems as they occurred; did the contractor suggest viable solutions?

Satisfactory Marginal Unsatisfactory N/A Comments:_____________________________________________________________________

3. How responsive was the contractor to contract changes?

4. How well did the contractor adhere to the contract schedule?

Comments:_____________________________________________________________________

5. How well did the contractor manage subcontractors on this project?

Satisfactory Marginal Unsatisfactory N/A Comments:_____________________________________________________________________

6. How well did the contractor provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements?

Satisfactory Marginal Unsatisfactory N/A Comments:_____________________________________________________________________

7. How well did the contractor provide emergency response to requests for support that conform to typical project requirements?

Satisfactory Marginal Unsatisfactory N/A

Comments: ____________________________________________________________________

8. Would you award this contractor another contract?

I would I might I would not Comments:_____________________________________________________________________

9. Did the contractor perform according to the contract’s Statement of Work?

Satisfactory Marginal Unsatisfactory N/A

10. Was the contractor cooperative, business-like and concerned with the interests of the customer?

Yes No

Comments: ____________________________________________________________________

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Do you know anyone else who can tell us about this contractor’s performance? (Please list Name, Phone No. and Fax No.)

Name:_____________________________ Phone:____________________ Fax:__________________

Name:_____________________________ Phone:____________________ Fax:__________________

Name:_____________________________ Phone:____________________ Fax:__________________

Name of Evaluator: ___________________________________________________________

Position Title /Grade: _________________________________________________________

Phone: ______________________________________________________________________

E-Mail: _____________________________________________________________________

Company: __________________________________________________________________

Length of time on project: _____________________________________________________

Date questionnaire completed: _________________________________________________