Attachment J-10. Past Performance Questionnaire.docx

1332KP26R0041

SECTION J - ATTACHMENT J-10

PAST PERFORMANCE QUESTIONNAIRE

Offeror/Contractor: Please complete Part 1 and provide each reference/evaluator with the form.

Reference/Evaluator: Please complete Part 2 and provide your candid responses. The information you provide will be used in the evaluation of the Offeror/Contractor for potential award of a federal contract or agreement; therefore, it is important that your information is factual, accurate, and complete as possible. If you do not have knowledge of or experience with the company in question, please forward to the person who does.

Please send completed questionnaire to Andrea.Chiodi@noaa.gov and Jame.Chang@noaa.gov no later than 3:00 PM (EDT) on October 19, 2026. The subject line in the submission email shall clearly indicate: “1332KP26R0041– Past Performance Questionnaire Submission for <Company Name>”, and the message shall originate from the reference’s government or commercial email address.

PART 1: (TO BE COMPLETED BY THE OFFEROR/CONTRACTOR)

A. NAME OF COMPANY BEING EVALUATED:

B. NAME/ADDRESS OF COMPANY PROVIDING EVALUATION INFORMATION:

Company Name:

Evaluator's Name and Title:

Address:

Telephone No.: E-mail Address:

C. PROJECT INFORMATION

(Under Work Description, include similarities/relevance to solicitation project AND a description of work performed to include specific requirements, location, and complexity.)

Contract No.:

Date of Award:

Project Title/Location:

Work Description:

Contract Type:

Original Contract Price:

Final Contract Price:

Original Completion Date:

Forecasted/Actual Completion Date:

Work was with: Commercial ☐ Fed. Gov't ☐ Local/City/State Gov't ☐

PART 2: EVALUATION (INFORMATION TO BE COMPLETED BY THE EVALUATOR RESPONDING FOR THE OFFEROR):

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor's control). An individual within your organization that is knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's (Offeror's) performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

Weaknesses or deficiencies were identified in their performance.

When responding use the dropdown options to select the response that most accurately describes the contractor's performance or situation. For any Exceptional, Marginal or Unsatisfactory rating assessed by the customer on individual elements or overall rating assigned on the past performance questionnaire, shall include an explanatory narrative to be provided in the remarks block. These narratives need not be lengthy, just adequate to support evidence of the specific ratings noted above. Failure to provide information supporting the assigned rating may result in a lower rating being designated than that assigned by the Evaluator. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legible. Your time and effort in providing this information is vitally important and is greatly appreciated.

SUCCESSFUL PERFORMANCE OF CONTRACT REQUIREMENTS

1. Has an election ever been made not to exercise an option or continue relations Choose an item.

due to the contractor's poor performance? If selecting YES, please provide a corresponding explanation in the remarks block.

2. Has a Contract Discrepancy Report ever been issued? Choose an item.

If selecting YES, please provide a corresponding explanation in the remarks block.

3. Has this contract been partially or completely terminated for default or Choose an item.

convenience? If selecting YES, please provide a corresponding explanation in the remarks block.

Partially ☐ Completely ☐

4. Overall rating of contractor's performance. Choose an item.

5. Would you contract with or hire this contractor again? Choose an item.

If selecting NO, please provide a corresponding explanation in the remarks block.

6. What role in contract administration did you perform (ie: CO, COR) and for how long?

Position: Click or tap here to enter text.

Length of Time: Click or tap here to enter text.

QUALITY AND TIMELINESS OF DELIVERY OF PRODUCTS AND SERVICES

1. Contractor's compliance with contractual terms and conditions. Choose an item.

2. Quality of products/services furnished. Choose an item.

3. Overall rating of contractor's quality of service. Choose an item.

EFFECTIVE MANAGEMENT OF SUBCONTRACTORS

1. Contractor's ability to manage and coordinate subcontractors to successfully Choose an item.

complete tasks.

COST CONTROL

1. Did the contractor successfully complete the project within budget? Choose an item.

If selecting NO, please provide a corresponding explanation in the remarks block.

LEVEL OF COMMUNICATION BETWEEN THE CONTRACTING PARTIES

1. Contractor's ability to communicate in a timely manner with stakeholders Choose an item.

especially when problems arose.

PROACTIVE MANAGEMENT

1. Contractor's ability to meet appropriate staffing levels with qualified Choose an item.

personnel in order to meet requirements.

2. Rate the contractor's ability to replace key personnel in a timely fashion. Choose an item.

3. Overall rating of contractor's management of key personnel. Choose an item.

CUSTOMER SATISFACTION

1. Contractor's ability to correct problems and prevent or mitigate potential Choose an item.

problems in a timely manner.

2. Contractor's ability to use effective approaches and provide technical Choose an item.

expertise and resources to solve contract problems.

3. Contractor’s willingness to improve and correct noncompliance issues. Choose an item.

4. Contractor's overall rating of customer satisfaction. Choose an item.

NOTE: For any Exceptional, Marginal, or Unsatisfactory ratings assessed by the customer when completing this form, please include an explanatory narrative in the “remarks” block below.

*REMARKS

Are you aware of other relevant past efforts performed by this company? If yes, please provide the name and telephone number of a point of contact.

1332KP26R0028 Attachment 5 Page 1 of 4

1332KP26R0028 Attachment 5 Page 4 of 4