Attachment 5-Past Performance Questionnaire.pdf

W911KF-22-Q-0025

Past Performance Questionnaire This Questionnaire relates to solicitation requirements for Self Contained Breathing Apparatus (SCBA)

PAST PERFORMANCE QUESTIONNAIRE –

Your assistance is requested in support of a source selection for Anniston Army Depot.

Please complete this Questionnaire and e-mail Director of Contracting Anniston Army Depot 7 Frankford Ave.

Anniston, AL 36201-4199

ATTN: Crystal Hodges, Contract Specialist Phone: 256-235-6231 E-mail: crystal.l.hodges8.civ@army.mil

Desired Response Date is the closing date of this solicitation.

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

Proposed prime contractor

1. OFFEROR NAME OFFEROR ADDRESS

Contractor Name and Address and contract/project information being addressed in this questionnaire

2. CONTRACTOR NAME & ADDRESS: 2. CONTRACT NO.:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options):

6. TYPE OF CONTRACT:

7. DESCRIPTION OF PROJECT REQUIREMENTS:

mailto:sara.b.young.civ@mail.mil

8. Point of Contact: Provide the following information for the company and individual completing this questionnaire:

Company/Agency Name and Address:

Name of person completing this questionnaire:

Title:

Role/responsibility for the effort being addressed in the survey:

Phone Number:

E-Mail:

Rating Scale:

EXCELLENT: Superior performance. Objectives/requirements essentially always achieved or exceeded, with inconsequential exceptions.

GOOD: Highly satisfactory performance. Objectives/requirements achieved with only rare exceptions, and the exceptions had minor consequences.

ADEQUATE: Generally satisfactory performance. Objectives/requirements generally achieved with occasional exceptions, and, in most cases, the exceptions had minor consequences.

MARGINAL: Occasionally unsatisfactory performance of significance.

Objectives/requirements were not fully achieved, with significant consequences in some cases.

POOR: Frequently unsatisfactory performance of significance. Objectives/requirements frequently not achieved, with significant consequences.

UNKNOWN: Unable to rate, not observed, or not a significant aspect of performance.

9. Questionnaire: Please indicate the rating that best reflects your experience with this contractor and provide a short narrative addressing the basis for the ratings assigned. Address compliance with requirements, actual performance, problems encountered and problem resolution. Use additional sheets if necessary. Excellent contract management, attention to Detail and Quality Assurance.

A. Customer Satisfaction – Assess the contractor’s business-like concern for its customers, including such factors as dependability, flexibility, early problem identification, communication, and responsiveness.

B. Schedule – Assess the contractor’s adherence to delivery commitments; responsiveness to requests for accelerations; and early identification and mitigation of schedule slippages.

C. Technical Requirements – Assess the contractor’s performance in conforming to contract specifications:

D. Technical Responsiveness – Assess the contractor’s ability to identify and resolve technical problems effectively and in a timely manner, including correction of faulty work and warranty claims:

Excellent Good Adequate Marginal Poor Unknown

Excellent Good Adequate Marginal Poor Unknown

Excellent Good Adequate Marginal Poor Unknown

E. Overall Assessment: Provide your overall assessment.

Past Performance Questionnaire