Attachment 5 - Past Performance Questionnaire.docx

WHEN FILLED IN THIS DOCUMENT IS

Source Selection Information – SEE FAR 3.104 – For Official Use Only

PAST PERFORMANCE QUESTIONNAIRE

Request for Proposal# 12318725Q0010

Past performance information is required for technical evaluation of quotes submitted in response to Request for Quote# 12318725Q0010- USDA FS LE&I Unmarked Vehicle Upfit. The Offeror shall ensure that a Past Performance Questionnaire is completed for each project referenced in their quote to be used to demonstrate experience in Factor 2, Past Performance. Relevant Past and Present Performance. The questionnaire is to be completed by the contracting activity (e.g., owners, clients, and prime contractors) responsible for the particular projects and furnished by the completing party directly and solely to the following individuals:

Drackus Thomas, Contract Specialist USDA FS WO-PPS, National Contracts Branch Email: drackus.thomas@usda.gov

MARK FOR: USDA FS LE&I Unmarked Vehicle Upfit

RFP: 12318725Q0010

Past Performance Information

Section I. Contractor Identification / Contract Information (to be completed by the Offeror)

Contractor Name / Address:

Contractor Key Personnel:

Program Name:

Client:

Contract Type: ( ) FFP ( ) Cost ( ) T&M/LH ( ) Other (Specify):

Competitive:

( ) Yes ( ) No If no, Set-Aside Type / Rationale:

Contract Value at Award:

Current Contract Value:

Contract Value Upon Completion:

Complexity:

Descriptions of Services:

Section II. Evaluation Ratings

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. The rating scale is defined as follows:

ACCEPTABLE (A)

The past performance record represents that the Offeror is capable of adequately performing the requirement. This rating indicates a low level of performance risk to the Government.

NEUTRAL (N)

Indicates that the Offerors references could not be verified or that the Offeror lacks relevant past performance experience.

UNACCEPTABLE (U)

Indicates that the Offeror has historically failed to perform in a satisfactory manner in the fulfillment of like or similar requirements. This rating indicates an unacceptable level of performance risk.

SECTION III: EVALUATION FACTORS

Ability to understand/comply with customer objectives and technical requirements.

Effectiveness of assigned personnel in terms of the appropriate mix of education and experience to accomplish the requirement.

Contractor proposed alternative methods/processes that improved the product or service which benefited the customer.

2. Program Management and Timeliness

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program).

Timeliness/effectiveness of contract problem resolution without extensive customer guidance.

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Accuracy in forecasting contract costs.

Ability to meet forecasted costs and perform within contract costs.

Ability to alert Government of unforeseen costs before they occur.

Sufficiency and timeliness of cost reporting.

Contractor proposed alternative methods/processes that reduced cost of product or service which benefited the customer.

SECTION IV: NARRATIVE SUMMARY

1. What were the contractor’s greatest strengths in the performance of the contract?

2. What were the contractor’s greatest weaknesses in the performance of the contract?

3. Would you hire this contractor in the future to perform one of your critical and demanding programs?

4. Please provide any additional comments concerning this contractor’s performance, as desired.

5. What is your overall customer satisfaction with this Contractor? (Please check) ( ) Acceptable ( ) Neutral ( ) Unacceptable

Reason for rating:

6. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

V. Respondent Information

The following information will assist with the analysis of the data.

TYPED OR PRINTED NAME & TITLE

Agency/company:

Address:

Work number (area code) Your role relative to the project/contract: (Administrative Contracting Officer, Inspector, Contract Administrator, Buyer, Quality Assurance Evaluator, Other - explain) Length of involvement in project/contract:

Do you know anyone else who can provide information regarding this Offeror’s performance (only fill if applicable)?

Email address

THANK YOU FOR YOUR ASSISTANCE IN COMPLETING THIS QUESTIONNAIRE

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