Attachment B - Past Performance Survey.docx

ATTACHMENT B

Past Performance Survey Cover Sheet

To Whom It May Concern:

The ___________________________ Company is currently responding to the U.S. Department of State RFP NO. 19AQMMA23R0071 to Simultaneous Interpretation Equipment and Services. They are requiring that clients of entities responding to their solicitations be identified and their participation in the evaluation process be requested. Therefore, we are requesting that you provide the following information regarding performance on the attached Past Performance Survey. Please submit the completed Survey directly via email from the customer reference to Jeanette C. Russell at RussellJ8@state.gov by close of the RFP. The “subject” line in the submission email should clearly indicate: RFP NO. 19AQMM23R0071 and the message shall originate from the Evaluator’s corporate or government email system.

By my signature below, I authorize you to respond to any additional inquiries by the U.S. Department of State regarding our performance on the referenced contract.

Signature _______________________________ Date __________________ Title ___________________________________

ATTACHMENT B

RFP NO. 19AQMM23R0071

PAST PERFORMANCE SURVEY

CONTRACT INFORMATION

a. Contractor: ________________________________________

b. Contract Number: ________________________________________

c. Type of Contract: (check all that apply)

I. ( ) Negotiated ( ) Sealed Bidding

ii. ( ) Competitive ( ) Non-Competitive

iii. ( ) Firm-Fixed-Price ( ) Cost-Plus-Fixed-Fee

( ) Time-and-Materials ( ) Labor Hour

( ) Indefinite Quantity ( ) Requirements

Other: __________________________________

d. Please complete the following:

Period of Performance: _________________ to ___________________

Initial Contract Value: $_____________________

Current (or Completed) Contract Value $_____________________

e. Brief description of requirement:

f. Complexity of effort: ( ) Difficult ( ) Routine

Please provide the following information (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Name of Evaluator: _________________________________ (Customer Contact)

Telephone Number: __________________________________

Facsimile Number: __________________________________

Organization/Office Symbol: ________________________

Mailing Address: ___________________________________

Position Title/Grade: ______________________________

Thank you in advance for completing this survey. THIS INFORMATION WILL BE PROTECTED IN ACCORDANCE WITH FAR 15.1004(e).

SCORING CRITERIA

EXCEPTIONAL - Indicates the Contractor’s performance within the area of evaluation clearly and consistently exceeds contractual requirements.

ACCEPTABLE - Indicates no problems in area of evaluation or has only minor problems for which solutions were satisfactory.

UNACCEPTABLE - Indicates serious problems in the evaluation area. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur.

SBU - CONTRACTING AND ACQUISITIONS