Attachment M - Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Note: Questionnaire submitted by some other entity other than the reference will not be accepted.

When filled in, this document is Source Selection Sensitive Information IAW FAR 3.104.

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor

B. Cage Code

C. Contract

Number

D. Contract Type

E. Was this a competitive contract? Yes No

F. Period of performance _

G. Initial contract cost $

H. Current/final contract cost $

I. Reasons for differences between initial contract cost and final contract costs

J. Description of service provided

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name

B. Customer or agency description

C. Geographic description of services under this contract, i.e., local, nationwide, worldwide, other commands

SECTION 3: EVALUATOR IDENTIFICATION

A. Name

B. Title

C. Phone/Fax

D. 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:

Code Performance Level

S Satisfactory – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M Marginal – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

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

NA Not Applicable – Unable to provide a score.

Small and Small Disadvantaged Business Participation S M US NA

S1. Ability to meet or exceed small business and small disadvantaged business goals set forth in the approved subcontracting plan.

S2. Ability to effectively manage small business participation to meet technical performance.

Technical Performance S M US NA

T1. Overall Contract Management.

T2. Adequacy of Contractor Workforce to Perform Contract.

T3. Quality Control.

T4. Government Furnished Property Administration.

T5. Contractor was reasonable and cooperative in dealing with your staff

(including the ability to successfully resolve disagreements/disputes).

T6. Timeliness/effectiveness of contract problem resolution without extensive customer guidance.

T7. Understand/complied with contract objectives and technical requirements.

T8. Ability to hire/apply a qualified workforce to this effort.

T9. Ability to retain a qualified workforce on this effort.

T10. Contractor ability to smoothly transition resources and personnel.

T11. Contractor effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

1. Please discuss each and every response for which you indicated M (Marginal) or

US (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

2. Government Contract Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes Default Convenience Pending Terminations No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc.).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

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

Evaluator’s Signature Date

Thank you for your prompt response and assistance.

Please return this completed questionnaire via email to all the following Contracting Officer and

Contract Specialist at the following email addresses: Karina.s.haddix.civ@mail.mil and

Salameya.paulouskaya2.civ@mail.mil.

mailto:Karina.s.haddix.civ@mail.mil mailto:Salameya.paulouskaya2.civ@mail.mil

Sample Questionnaire Cover Letter

Letterhead

Date

FOR OFFICIAL USE ONLY

The Mission and Installation Contracting (MICC) – Fort Sam Houston (FSH) Contracting Center is in the process of selecting a contractor for Army Food Services. The services required are for the Fort Wainwright’s Dining Facilities in support of the installation food services program that support the Warfighter with flexible, efficient and cost effective service. The service encompasses dining facility functions, food preparation, facility sanitation, and janitorial duties.

One of the considerations in proposal evaluation is the verification of the offeror’s past performance on contracts, which reflect the offeror’s ability to perform on the proposed effort.

We depend on information received from agencies such as yours, which have had first-hand experience with an offeror, for the evaluation of the offeror’s performance on those contracts.

Our areas of interest in the offeror are summarized in the enclosed questionnaire. Our schedule is extremely tight and we need your written response no later than (INSERT DATE) after your receipt of this letter. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and emailed to all the following Contracting Officer and Contract Specialist at:

Karina.s.haddix.civ@mail.mil and Salameya.paulouskaya2.civ@mail.mil. Please email the

Contracting Officer or Contract Specialist prior to transmission or if you have any questions.

Your completed questionnaire will become a part of the official Source Selection records.

Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this source selection.

mailto:Karina.s.haddix.civ@mail.mil mailto:Salameya.paulouskaya2.civ@mail.mil