Attachment 5 - Past Performance Questionnaire.docx

Attachment 5: Past Performance Questionnaire (Solicitation No. SPE5B1-25-R-0002)

NOTE TO RECIPIENT:

a) Per FAR 15.306(e)(4), the Government will not reveal the names of individuals providing reference information about an offeror’s past performance.

b) The offeror is solely responsible for ensuring references complete and submit this questionnaire to the Government by the required due date. Please submit this completed questionnaire directly to the following points of contact no later than solicitation closing date:

PART I – OFFEROR’S INFORMATION (To be completed by Offeror):

OFFEROR IDENTIFICATION

Offeror/Company Name:

Offeror/Company Address:

Offeror/Company DUNS:

Offeror/Company CAGE Code:

Offeror/Company Point(s) of Contact (POCs):

Offeror/Company POC E-mail:

Offeror/Company POC Phone:

PART II – CONTRACTUAL INFORMATION (To be completed by Offeror Reference):

CONTRACTUAL INFORMATION. Please provide the following information regarding contractor identified in Part I above:

Reference Contract Title: __________________________________ Contract #: ____________________________

Reference POC Name: _______________________________________________

Role/Title for This Contract: _________________________________ How Long in this Role: _________________ POC Phone: ______________________________ POC E-mail: _________________________________________

Contract Performance Location: ___________________________________________________________________

Performance Start Date: _________________________ Contract Completion Date: __________________________

Total Contract Dollar Value: $_____________________________________

Description of Contract Requirements and Work Performed by the Contractor:

Significant Risks in Performance of the Contract:

PART III – RATINGS AND QUESTIONS (To be completed by recipient):

Questionnaire Instructions to Recipient

Based on the following adjectival ratings scale, please evaluate the quality of the offeror’s performance by selecting the appropriate ratings and applying to elements 1 through 5 on the following pages.

SCALE:

NOT

APPLICABLE

UNSATISFACTORY

MARGINAL

SATISFACTORY

N/A

DEFINITIONS:

EXCEPTIONAL: Performance met and exceeded many contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VERY GOOD: Performance met and exceeded some contractual requirements. 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 met 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 did 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 marginally effective or were not fully implemented.

UNSATISFACTORY: Performance did not meet most contractual requirements and recovery in a timely manner is not likely. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective action(s) appear or was/were ineffective.

NOT APPLICABLE: Self-explanatory.

If more space is required, use the back of the questionnaire or attach additional pages. Ratings should only reflect the performance of the contractor in question.

Question Categories

Would your organization award another contract to this contractor? (select one)

YES |_| NO |_|