Attachment 4 - Sample Questionnaire Cover Letter and Past Performance Questionnaire.docx

SAMPLE QUESTIONNAIRE COVER LETTER

LETTERHEAD

(Date)

FOR OFFICIAL USE ONLY

The (Name of Installation Contracting Office (ICO) of the Mission and Installation Contracting Command (MICC) is in the process of selecting a contractor for a (name of program) program. (Describe in general terms the nature of the effort).

One of the considerations in proposal evaluation is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had firsthand experience with an offeror, for the evaluation of the offeror's performance on those contracts.

Our areas of interest in the offeror are summarized in the enclosed questionnaire. As discussed in our initial phone contact with your office, our schedule is extremely tight and we need your written response no later than (NLT) _______ calendar days (Recommend incorporating the date the solicitation/RFP closes) after your receipt of this letter. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and "faxed/emailed" to XXXXX-XXXX (Attention: ______________). Please call _______________at (XXX) XXX-XXXX prior to transmission or if you have any questions. Your completed questionnaire will become a part of the official Source Selection records.

Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor:____________________ Contract No.:____________________________ Subcontract No. (if applicable):_________________________________

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Outstanding: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

B. Effectiveness of Project Management (to include use and control of subcontractors).

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

C. Timeliness of Performance for Services and Product Deliverables.

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unsatisfactory (Explanation must be provided in Comments field below)

F. General Comments. Provide any other relevant performance information.

G. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contracting Officer identified in the cover letter.

Thank you for your assistance.

Typed or Printed Name