Attachment J-3 PAST PERFORMANCE EVALUATION QUESTIONNAIRE.pdf

PAST PERFORMANCE EVALUATION

QUESTIONNAIRE Solicitation FDA-SOL-1225400

1. Contract Identification: (to be completed by offeror)

Offeror Name and Address, Offeror Point of Contact Name/Title, Telephone Number, and E-Mail Address:

Reference Information: Agency/Company Name and Address, Agency Point of Contact Name/Title, Telephone Number, E-Mail Address, and Contract Number for/ to whom this questionnaire was submitted:

Location of Work:

Description of Work:

Relevance of the referenced contract to the current requirement:

Problems Encountered in Performance and Corrective Actions Taken:

Company’s capacity served on the project, ie, prime, subcontractor, key personnel.

Project Manager/Engineer, and other Lead Engineers (including any major subcontractors) serving as Key Personnel on the project.

Contract Information:

Contract Number:

Contract Type:

Period of Performance:

Original Contract Amount:

Final Contract Amount:

Final Completion Date:

2. Agency/Company Identification: (to be completed by Client)

Description of Work Performed and the Contractor’s Association with the Project (Prime, Subcontractor, etc).

Reason for difference (if any) between original contract amount and final contract amount:

Reason for difference (if any) between original contract completion date and final completion date:

3. Contractor Performance Ratings:

Please rate the Contractor’s performance by utilizing the rating and definition provided below; it is imperative that ratings be accompanied by supporting narrative (comments):

Rating Definition

Outstanding

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

Above Average

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

Satisfactory Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory

Performance does not meet significant 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.

A. Timeliness of Performance

1. To what extent did the contractor adhere to contract delivery schedules? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

2. To what extent did the contractor submit required reports and documentation in a timely manner? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

B. Quality of Work

1. To what extent were the contractor’s reports and documentation accurate and complete? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

2. To what extent was the contractor able to solve contract performance problems without extensive guidance from Company/Government counterparts? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

3. Did the contractor provide a product or service that conformed to contract requirements, specifications, and standards of good workmanship? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

C. Business Relations

1. To what extent did the contractor commit adequate resources to the contract in a timely fashion in order to meet the requirements and to successfully solve problems? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

2. To what extent did the contractor submit change orders and other required proposals in a timely manner? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

3. To what extent did the contractor respond positively and promptly to technical directions, contract modifications, etc.? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

4. To what extent was the contractor effective in interfacing with the Company/Government’s staff? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

5. Has this contract been partially or completely terminated for default or convenience? (Ratings Must Be Supported by Comments)

( )Yes ( ) No ( )Default ( )Convenience

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

D. Cost Control

1. How well did the firm submit accurate price information for change order?

(Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

2. Did the applicant initiate unwarranted change orders or change order requests?

(Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

E. Management of Key Personnel

1. Did the contractor use personnel with the appropriate skills and expertise to fulfill the requirements of the contract? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

2. Did the contractor retain the necessary skilled personnel and maintain a low turnover rate? (Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

F. General

1. Were you satisfied overall with the Contractor’s performance?

( )Yes ( ) No

Comments:

2. Would you do business with this contractor again?

( )Yes ( ) No

Comments:

3. In summary, provide an overall rating for the work performed by this contractor.

(Ratings Must Be Supported by Comments)

Outstanding ( ) Above Average ( ) Satisfactory ( ) Marginal ( ) Unsatisfactory ( )

Comments:

G. Evaluator Information:

Name (please print):

Title:

Work phone number (including area code):

FAX number (including area code):

E-Mail address:

Signature: