Attachment_B_-_Past_Performance_Questionnaire.docx

Attachment B - Past Performance Questionnaire Solicitation 140D0425Q0621

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Offeror:

B. Offeror Role: (Prime or Sub) ______________________________________________________

C. Agency/Customer: ________________________

D. Contract Title: __________________________________________________________________

E. Contract Number: _______________________________________________________________

F. Contract type: _____________________________________________________________ ____ G. Location of Services: _____________________________________________________________ H. Was this a competitive contract? Yes No

I. Period of performance:

J. Initial contract cost: $

Current/final contract cost: $

K. Reasons for differences between initial contract cost and final contract costs:

L. Project Description:

SECTION 2: RESPONDENT IDENTIFICATION

A. Respondent’s name and title:

B. Respondent’s Email Address:

C. Number of years respondent worked on subject contract:

SECTION 3: EVALUATION

Please indicate your satisfaction with the contractor’s performance by marking the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

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

VG VERY GOOD – Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

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

N/A NOT APPLICABLE – Does not apply to this contract/task order.

Ability to understand/comply with customer objectives and technical requirements

Effectiveness of assigned personnel in terms of the appropriate mix of experience to accomplish the requirement.

Adequacy/effectiveness of quality control

Quality/effectiveness of sub-contracted efforts

Did the contractor meet all required safety and compliance requirements? __________________________

If not, please explain_____________________________________________________________________

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Timeliness of contract / Ability to meet schedule requirements

Ability to successfully respond to emergency and/or surge situations

Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes). Provided problem resolution without extensive customer guidance.

Government Contracts Only: has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes Default Convenience Pending Termination No

Narrative Summary:

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature

Thank you for your prompt response and assistance!

Please return this completed questionnaire to the requestor for inclusion in their quote submission. If you prefer to send it directly to the CO, please send it to the following email address and notify the contractor of its submission:

Ericka Graham, ericka_graham@ibc.doi.gov