Attachment 6 - Past Performance Questionnaire.docx

Performance Assessment Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does [and/or notify the Contracting Officer]. Please return the completed Questionnaire to Richard J. Buelow II (Contract Specialist) at Richard.j.buelow.civ@army.mil and Cheryl M. Todd (Contracting Officer) at Cheryl.m.todd.civ@army.mil.

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror) A.

CONTRACT

IDENTIFICATION

Contractor/Company Name/Division:

Address:

SOURCE SELECTION INFORMATION (SEE FAR 3.104)

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above): Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

B.

IDENTIFICATION

OF

OFFEROR’S

REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: rationale is required for each response.

A. Compliance of Products, Services, Documents, and Related Deliverables to

Specification

Requirements and

Standards of

Good

Workmanship

· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· No Confidence

Rationale:

B. Effectiveness of Project Management (to include use and control of subcontractors).

· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

Rationale:

SOURCE SELECTION INFORMATION (SEE FAR 3.104)

C.

Timeliness of

Performance for

Services and

Product

Deliverables.

· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

Rationale:

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this

Question on

Cost Reimbursement

Type Contracts

Only)

· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

Rationale:

E. Commitment to Customer Satisfaction and Business-like Concern for its

Customers’

Interest

· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

Rationale:

F.

General

Comments.

Provide any other relevant performance information.

Comments:

G.

Other

Information

Sources.

Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name): Telephone Number:

H.

Respondent

Identification.

Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter.

Thank you for your assistance.