Attachment J2 - Blind Past Performance Questionnaire.doc

ATTACHMENT J2 – BLIND PAST PERFORMANCE QUESTIONNAIRE

030ADV22R0013 – SECONDARY INTERNET SERVICE PROVIDER

PAST PERFORMANCE QUESTIONNAIRE

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

SECTION 1: CONTRACT IDENTIFICATION

A.

Contractor: _______________________________________ B.

Agency Contract number:____________________________________

C.

Contract type:______________________________________ D.

Was this a competitive contract? Yes

No

E.

Period of performance: _________________ F.

Contract cost or price:___________________________________ G.

Description of work:____________________________________________________________________ Government Contracts Only: Was this contract partially or fully terminated for default or convenience or are there any pending terminations?

Default______

Convenience______

Pending Termination______ If any applies, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc): ____________________________________________________________________________________________

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A.

Customer or agency name: _________________________________________________________________________ B.

Geographic description of services under this contract, i.e. local, nationwide, worldwide:

SECTION 3: EVALUATOR IDENTIFICATION

A.

Evaluator's name and title: __________________________________________________________________________.

B.

Evaluator's phone/fax number: _______________________________________________________________________.

C.

Number of years evaluator worked on subject contract:_____________________.

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor's performance by placing an "X" in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

· Not Applicable: N/A

· 1: Performance clearly below the contract performance standard or requirement

· 2:

Performance occasionally does not meet minimum contract performance standard or requirement

· 3:

Performance that meets the minimum contract performance standard or requirement

· 4:

Performance that meets and occasionally exceeds the contract performance standard or requirement

· 5:

Performance that almost always exceeds the contract performance standard or requirement

Overall satisfaction with performance. Would you (the reference) choose to work with this offeror again?

Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.

Schedule includes delivery consistency, on-time performance, and flexibility in responding to emerging issues.

Cost/price refers to the offeror’s ability to manage the work within the agreed upon cost or price.

Rate the quality of the contractor’s staff in executing the project work scope.

This includes quality and timeliness in sourcing, invoicing, and reporting under the contract.

This includes the offeror’s ability to communicate and solve problems in a timely and effective manner.

SECTION 5: NARRATIVE SUMMARY

What were the contractor's greatest strengths in performance of the contract?

What were the contractor's greatest weaknesses in the performance of the contract?

Would you hire this contractor in the future to perform one of your critical and demanding programs?

Evaluator Signature:

Date:

Thank you for your prompt response and assistance!

Please return this completed questionnaire to: Gail Macfarquhar and Tiffany Lucas Email Address: gmac@loc.gov and tluc@loc.gov Subject: RFP 030ADV22R0013 Attachment