Attachment 4 - Past Performance Questionnaire.doc

Attachment 4

PAST PERFORMANCE QUESTIONNAIRE

I.

CONTRACT IDENTIFICATION

A.

CONTRACTOR

B.

CONTRACT NO.

C.

CONTRACT TYPE

D.

PERIOD OF PERFORMANCE _____________________________________

E.

ACTUAL OR ESTIMATED

CONTRACT TOTAL _____________________________________________

(Including all possible option periods)

F.

DESCRIPTION OF REQUIREMENT ________________________________

II.

AGENCY IDENTIFICATION

NAME OF GOVERNMENT ACTIVITY ___________________________________

(Include point of contact/phone #/ ___________________________________ fax #/address) ___________________________________

III.

ASSESSMENT OF CONTRACTOR PERFORMANCE

Please rate the contractor’s performance in the following categories on a scale of 0 to 6 as follows:

1 = Marginal

2 = Satisfactory

3 = Neutral

4 = Good

5 = Outstanding

Also, please provide an explanation in support of each rating in the space provided.

A.

QUALITY OF PERFORMANCE: Please rate/explain the quality of the contractor’s performance; conformance to contract requirements and statement of work; and, quality of products and/or services.

1 2 3 4 5 (Circle one)

B.

TIMELINESS OF PERFORMANCE: Please rate/explain the timeliness of the contractor’s performance, adherence to contract schedules, including completing work efforts on time.

C.

BUSINESS RELATIONS: Please rate/explain the contractor’s management abilities including its ability to solve performance problems.

1 2 3 4 5 (Circle one)

D.

COMMITMENT TO CUSTOMER SATISFACTION: Please rate/explain the contractor’s communications with the Government staff, reporting of problems and effectiveness of contractor interface with Government staff.

E.

COST CONTROL: Please rate/explain the contractor’s cost control capabilities and accuracy of any projected cost changes.

1 2 3 4 5 (Circle one)

F.

TECHNOLOGY: Please rate/explain the contractor’s manner and effectiveness in ensuring that information technology systems kept pace with the requirements of the Statement of Work.

1 2 3 4 5 (Circle one)

G.

INNOVATION: Did this contract require the contractor to use innovative technical approaches? YES NO (Circle)

Additional information or comments:

H.

Would you recommend selection of this contractor again?

YES

NO (Circle)

Additional information or comments:

Source Selection Information – See FAR 2.101 and 3.104