Attachment Z- Past Performance Questionnaire.docx

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Attached to
Consolidated Receiving Point Services- U. S. Despatch Agency Seattle, WA
Solicitation number
19AQMM21R0024
Issued by

About this file

This solicitation requests proposals for packing, crating, receiving, containerization, and storage services. The Department of State seeks these services for its U.S. Despatch Agency in Seattle, Washington, to receive items shipping from U.S. sources to overseas embassies and consolidate them for shipping. Required services include receipt, inspection, inventorying, consolidation, export packing, temporary storage, and delivery of U.S. Government-owned furniture, supplies, vehicles, equipment and household effects of employees. The performance period is one base year plus four one-year options under a firm fixed price contract awarded to a single small business. The closing date for proposals is April 5, 2021, with questions due by March 9, 2021. The solicitation requires separate electronic submissions of technical and price proposals no larger than 8 MB each. The National American Individual Classification Standard code is 493110.

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Text version

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and email to:

Department of State – Office of Acquisition Management

A/OPE/AQM/WWD/FBSB

ATTN: Travis Keon, Contracting Officer keontc@state.gov (this is preferable method of receipt) Desired Response Date: April 3, 2021

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS:

2. CONTRACT NO.:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION: DVIDS Director

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

O = Outstanding E = Excellent A = Adequate M = Marginal P = Poor N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

O E A M P N/O

B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

O E A M P N/O

C. Schedule – Assess the timeliness of contractor against the schedule of activities.

O E A M P N/O

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

O E A M P N/O

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

O E A M P N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

O E A M P N/O

G. Overall Assessment.

O E A M P N/O

If an Award Fee contract, what was the average Award Fee % earned?

SBU - CONTRACTING AND ACQUISITIONS

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