Attachment Z-Past Performance Questionnaire.docx
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- Solicitation number
- 19AQMM25R0003
About this file
This document is a Performance Questionnaire to be completed by an evaluating organization representative providing feedback on a contractor's past performance. The questionnaire covers factors such as quality of products/services, performance, schedule, technical requirements, cost control, and customer satisfaction. The contractor information includes the contract number, initiation date, completion date, contract value, and contract type.
The related federal contract opportunity is a Request for Proposals (RFP) issued by the Department of State for consolidated receiving point services, including packing/crating, receiving, containerization, and warehouse storage services for the U.S. Despatch Agency in Miami, FL. The contract is anticipated to be a single award of a firm fixed price Indefinite Delivery/Indefinite Quantity contract for a one-year base period plus four one-year options. The acquisition is a 100% SBA Certified 8(a) small business set-aside with a NAICS code of 493190.
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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/GA/AMD/WWD/FBSB
ATTN: Travis Keon, Contracting Officer keontc@state.gov (this is preferable method of receipt) Desired Response Date: December 1, 2025
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/SUBCONTRACTOR 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 AND EMAIL: 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
Any other relative information to support the above ratings:
SBU - CONTRACTING AND ACQUISITIONS
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