Attachment_A_Past_Performance_Questionaaire.pdf

CONTROLLED UNCLASSIFIED INFORMATION

Source Selection Information -- See FAR 2.101 and 3.104

FA8534-22-R-0002

ATTACHMENT A

Past Performance Questionnaire

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Description of work performed:

J. Was this a competitively awarded contract? ☐ Yes ☐ No

K. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other

Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Section 4: Performance Information

In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under each question. Provide supporting information for each response in the space provided. If supporting documentation is not provided for ratings other than “satisfactory,” the ratings will be considered to be unsubstantiated and will be interpreted as satisfactory. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

Code Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know.

E V S M U N/A

1. Extent to which the company’s products met the requirements of the customer’s contract or project?

SUPPORTING INFORMATION:

2. Configuration Management (first product delivered same as last product delivered):

3. Quality of Completed Product:

4. Overall management of Subcontracting efforts:

5. Quality of Technical manuals or Commercial Manuals:

6. Customer’s Satisfaction with warranty response times and corrective actions:

7. Adequate Number of dedicated resources for your program:

8. Company performed independently without significant customer direction/oversight:

9. Timely recognition and notification of administrative, engineering, production problem affecting the program:

10. Monitoring of Program Schedules and Critical Milestones:

11. Completed work on time:

12. Extent to which Small businesses, veteran-owned small business, small disadvantaged businesses and other socio-economic business sectors were utilized in the performance of the contract:

13. Have there been any disputes/claims relative to the contract? If yes, explain.

14. Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract.

15. Additional Remarks.

Government Contracts Only: Was this contract partially or completely terminated for default or convenience, or are there any pending terminations?

_• Yes _• Default _• Convenience _• Pending Terminations _• No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

SECTION 5: GENERAL COMMENT

Given what I know today about the contractor’s ability to execute what he promised in his proposal, I __________________ award to him today given that I had a choice.

Respondent’s Signature Date

Thank you for your prompt response and assistance!