Attachment 8_Past Performance Questionnaire.pdf

Past Performance Questionnaire

This Questionnaire relates to a solicitation for _W911KF-21-R-0277_.

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and e-mail or send by facsimile Army Contracting Command – ANAD (DTA) Anniston Army Depot 7 Frankford Ave.

Anniston, AL 36201-4199

ATTN: Sara B. Young;

sara.b.young.civ@mail.mil

Desired Response Date:

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

1. 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 CONTRACT REQUIREMENTS:

Please provide a copy of the complete Performance Work Statement or Scope of Work for each of the evaluated contract.

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER:

c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A –G) that best reflects your experience with this contractor.

SUB = Substantial Confidence SAT = Satisfactory Confidence N = Neutral Confidence L = Limited Confidence NO = No Confidence

Please provide a short narrative addressing the basis for the ratings assigned; address compliance with requirements, actual performance, problems encountered and problem resolution.

Use additional pages as needed.

A. Quality – Assess the contractor’s ability to staff the contract with a dedicated Site Manager, a dedicated Project Manager and a dedicated Quality Control Manager.

SUB SAT N L NO

Narrative (A): Quality – Assess the contractor’s ability to staff the contract with a dedicated Site Manager, a dedicated Project Manager and a dedicated Quality Control Manager:

B. Quality – Assess contractor’s ability to manage multiple projects simultaneously.

Narrative (B): Quality – Assess contractor’s ability to manage multiple projects simultaneously:

C. Quality – Assess contractor’s ability to manage the performance of their employees and subcontractors.

Narrative (C): Quality – Assess contractor’s ability to manage the performance of their employees and subcontractors:

D. Quality - Assess contractor’s ability to deliver quality work that meets all of the contract requirements.

Narrative (D): Quality - Assess contractor’s ability to deliver quality work that meets all of the contract requirements:

E. Schedule – Assess contractor’s ability to meet the contract period of performance with few or no extensions.

Narrative (E): Schedule – Assess contractor’s ability to meet the contract period of performance with few or no extensions:

F. Certification Compliance – Assess the contractor’s ability to meet all Federal, State, and Local certification requirements:

SUB SAT N L NO

Narrative (F): Certification Compliance – Assess the contractor’s ability to meet all Federal, State, and Local certification requirements:

G. Overall Assessment –

Narrative (G): Overall Assessment: