B08 - ATTACH_0010_Performance Assessment Questionnaire.pdf
PDF 165 KB Posted
- Attached to
- The Family of Hand Held Signals
- Solicitation number
- W519TC-23-R-0080
About this file
This document is a Past Performance Questionnaire template for evaluating contractor performance on the Family of Hand Held Signals contract under Request for Proposal W519TC-23-R-0080, administered by the Army Contracting Command - Rock Island.
The questionnaire is designed to be completed by identified points of contact who have worked with the contractor on related contracts or purchase orders. Responses must be submitted by September 8, 2026, to benjamin.c.riessen.civ@army.mil. The form requests evaluation across seven key performance areas: adherence to original delivery schedules and reasons for any delays; timeliness and quality of Requests for Variance and Engineering Change Proposals, along with any First Article Test or Lot Acceptance Test failures; contract termination status; critical characteristic failures and associated Failure Analysis Corrective Action Reports; overall quality assessment; responsiveness to information requests; and contractor-customer relationship quality. Each section requests both quantitative data (number of delays, failures, revisions) and qualitative commentary explaining the rationale for ratings. Respondents must provide their name, title, phone number, company/agency affiliation, contract number, and length of involvement with the contractor, and sign and date the completed form.
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Text version
SOURCE SELECTION INFORMATION (SEE FAR 3.104)
Enclosure 2 - Performance Assessment Questionnaire
Past Performance Questionnaire Family of Hand Held Signals
Request for Proposal W519TC-23-R-0080
The Army Contracting Command - Rock Island appreciates your input on the below Contractor’s performance by taking a few moments to provide past performance information on the contract / purchase order you have been identified as the POC for.
Your time and effort is greatly appreciated. Please submit the completed questionnaire to benjamin.c.riessen.civ@army.mil. If you have any questions with regard to this request, please don’t hesitate to contact Benjamin Riessen at the email above.
Questionnaire is being completed for Contractor:
Name of Company/Government Agency completing Questionnaire:
Contract/Purchase Order Number:
Name, title, and phone number of person completing Questionnaire:
Length of time your firm/agency has been involved with the Contractor:
PLEASE SUBMIT PAST PERFORMANCE QUESTIONNAIRE BY 8 SEP
2026 TO: benjamin.c.riessen.civ@army.mil
1. Did the contractor meet the original contract delivery schedule? Yes ___ No ____
a. If no, was it contractor or Government caused delay?
b. If contractor, why?
c. How many times was the delivery schedule revised due to contractor delay?
mailto:benjamin.c.riessen.civ@army.mil mailto:benjamin.c.riessen.civ@army.mil
SOURCE SELECTION INFORMATION (SEE FAR 3.104)
d. If yes, was the contractor ahead of schedule and what benefit did it provide to the Government?
2. Throughout the course of your contract:
a. Requests for Variance (RFVs) and/or Engineering Change Proposals (ECPs): How would you rate the timeliness and quality of these submissions?
b. Did the contractor have any First Article Test or Lot Acceptance Test failures? If yes, please specify how this failure impacted the Government.
c. Was the contract terminated for any reason? Please specify if applicable.
3. Critical characteristic failures:
a. How would you rate the timeliness and quality of Failure Analysis Corrective Action Reports (FACARs)?
b. How many critical characteristic failures did the Contractor have?
c. Did the critical failures cause a major delay in schedule? If so, how many times and what was the impact to the Government?
4. How would you describe the overall quality of the contractor? WHY?
5. Was the contractor responsiveness to requests for information? WHY?
6. How would you describe the contractor/customer relationship for this contract? WHY?
7. Any other comments regarding Quality, Delivery Schedule Performance/On-Time Delivery or about the contractor’s past performance in general?
Signature of person submitting Questionnaire Date
| Enclosure 2 Performance Assessment Questionnaire: |
| Did the contractor meet the original contract delivery schedule Yes: |
| No: |
| Date_4: |
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