Attachment 5 Past Performance Questionnaire.pdf

Attachment 5 - PAST PERFORMANCE QUESTIONNAIRE

This attachment requires input from your provided Reference. Please ensure block 5-8 are completed by the Reference. This attachment can be sent directly to the Government by the Reference to BulkFuelsBidCustodian@dla.mil prior to the closing date of this solicitation. The subject line of the email correspondence must specify the solicitation number and the Offeror name to which this attachment is being submitted.

CONTRACT INFORMATION (Offeror to complete blocks 1-4)

1. Contractor Information:

CONTRACTOR NAME: CCR CAGE CODE:

ADDRESS: CCR DUNs NUMBER:

PHONE NUMBER:

EMAIL ADDRESS:

POINT OF CONTACT: CONTACT PHONE NUMBER:

2. Work Performed as: ______ Prime Contractor ______ Sub Contractor ______ Join Venture ______ Other (Explain)

If subcontractor, who was the prime (Name/Phone#):

3. Contract Information

Contract Number:

Contract Type: _________ Firm Fixed Price __________ Cost Reimbursement _________ Other (Please specify):

Contract Title:

mailto:BulkFuelsBidCustodian@dla.mil

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Contract Description:

Complexity of Work: ________ High ________ Med _________ Routine

How is this contract relevant to the requirement of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Reference to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the reference’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

Attachment 5 - PAST PERFORMANCE QUESTIONNAIRE Continued

EVALUATION. Please rate the Contractor utilizing the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Evaluation Definitions –

The following definitions should be used in the assessment of Contractor performance.

EXCEPTIONAL

Performance EXCEEDS MOST contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns.

VERY GOOD

Performance EXCEEDS SOME contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns, for which the Contractor’s corrective actions were highly effective.

SATISFACTORY

Performance MEETS contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the Contractor were effective.

MARGINAL

Performance MEETS SOME contractual requirements. The performance of the areas being assessed includes significant problems, issues, or concerns for which corrective actions taken by the Contractor were only somewhat effective.

UNSATISFACTORY

Performance DOES NOT MEET contractual requirement. The performance of the areas being assessed includes serious problems, issues, or concerns for which the Contractor’s corrective actions were ineffective.

NOT APPLICABLE (N/A) Performance information not recent or relevant as defined in the Solicitation. Unable to provide assessment.

Evaluation Question 1.

Performance

What is your assessment of the Contractor’s ability to meet your requirements?

Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

Performance

Comments, if any.

Questions 2 . Timeliness

What is your assessment of the Contractor’s ability to provide products in a timely manner?

Timeliness

Ability to Resolve Problems Timely

Question 3. Quality of Workload Management

What is your assessment of the Contractor’s ability to manage workload, produce quality deliverables and coordinate with subcontractors ( if any) to meet requirements of the applicable performance work statement?

Quality of Management

Question 4. Overall Rating of Contractor’s performance

What is your overall rating of Contractor’s performance (requirements, schedule) on contract being assessed?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

General Comments: