Attachment Z- Past Performance Questionnaire.docx

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: March 1, 2023

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:

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 Prime Contractor or Subcontractor (as appropriate) for project related to warehousing, shipping/receiving.

O E A M P N/O

C. Schedule – Assess the timeliness of contractor against the schedule of activities, deliveries, receiving, performing warehouse and shipping services.

O E A M P N/O

D. Technical Requirements – Assess the contractor’s ability to perform the technical requirements of the contract, as it relates to warehousing, shipping/receiving freight.

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, claims, and feedback.

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