Attachment 5 - Past Performance Questionnaire v3.docx

Past Performance Questionnaire

The United States Securities and Exchange Commission, Office of Acquisitions, intends to acquire Supplemental Benefits Program (SBP) services to include dental and visions plans, medical evacuation insurance, and other voluntary benefits for its employees. As part of the procurement process, an increased emphasis is being placed on past performance as a source selection factor.

In order to accurately evaluate the Offeror’s past performance, your assistance is requested in obtaining and verifying the past performance history of this Offeror. It is important to note that names of individuals providing reference information about an Offeror’s past performance will not be released to the contractor.

Two forms are provided to complete the evaluation: 1) Performance Rating Form; and 2) Additional Comment Form. Upon completion of these forms, please submit the forms as an e-mailed attachment to J. Christie Branham at branhamj@sec.gov and Gabriel Aviles at avilesg@sec.gov. Please make sure the subject line of the e-mail reads “50310225R0006 - Past Performance Questionnaire – Insert Evaluated Company’s Name.” Submissions must be received by Friday, May 30, 2025 at 12:00 PM ET.

The following standards shall be used in arriving at the rating.

Exceptional Contractor’s performance exceeded customer expectations or contract requirements, demonstrated an exceptional understanding of the requirements and provided significant features or benefits.

Acceptable Contractor met customer expectations or contract requirements and demonstrated an acceptable understanding of the requirements.

Marginal Contractor’s barely met customer expectations or contract requirements and demonstrated a marginal understanding of the requirements.

Unacceptable Contractor did not meet customer expectations or contract requirements and demonstrated an unacceptable understanding of the requirements.

Other If the element is not applicable, indicate with “N/A.” If no data has been obtained or additional comments are provided, please note in this column.

Performance Rating Form

NAME OF COMPANY EVALUATED:

ADDRESS OF COMPANY EVALUATED:

CONTRACT NUMBER

CONTRACT PERIOD OF PERFORMANCE

CONTRACTING OFFICER NAME,

ADDRESS, FAX AND TELEPHONE NUMBER, AND EMAIL ADDRESS

TYPE OF SERVICES PERFORMED (ACTIVITY):

Technical Performance (Quality of Product or Services)

1. QUALITY OF TECHNICAL APPROACH

(For example: Were the products acceptable and were the services comprehensive, complete, and feasible? (Met the needs, performed successfully, and accommodated changing requirements.)

2. UNDERSTANDING OF REQUIREMENTS

(For example: Did the contractor show an understanding of the scope of the requirements and an appreciation of the complexity of the requirements? And did the contractor effectively identify flaws, inconsistencies and other inaccuracies in your technical direction?)

Timeliness of Performance

3. EFFECTIVE AND EFFICIENT USE OF RESOURCES

(For example: Was the contractor able to obtain in a timely manner the amount and type of product and personnel resources required to support the project, effectively train personnel to perform the work required for the project, and maintain the required workforce throughout the term of the contract?)

4. TIMELINESS OF PERFORMANCE

(For example: Was the contractor successful in planning and proposing realistic schedules, monitoring performance, completing work on time, and implementing corrections/changes in a timely manner?)

QUALITY/CUSTOMER SATISFACTION

5. QUALITY OF PERFORMANCE/CUSTOMER SATISFACTION

(For example: Was the contractor committed to customer satisfaction?)

6. BUSINESS BEHAVIOR

(For example: Was the contractor reasonable and cooperative at the corporate and program levels in response to changes in technical direction, correcting errors, poor performance, criticism/rejection of contract deliverables and other quality issues?)

7. COMMUNICATION

(For example: Did the contractor work and communicate well with contracting officers, contracting officer’s technical representatives, end users, other contractors, subcontractors, and in-house staff?)

COST CONTROL

8. COST CONTROL

(For example: Was the contractor successful in planning and proposing realistic costs, monitoring performance, operating at or below budget, and implementing corrections/changes in a cost effective manner?)

9. Given the choice, would you do business with this contractor again?

Additional Comment Form

Please provide any additional comments regarding your performance element ratings in the space below. Please add additional pages as necessary.