B08_SOL_140D0426Q0416_Attach_3_PPQ.docx

ATTACHMENT 3-PAST PERFORMANCE QUESTIONNAIRE FORM

This is a questionnaire to evaluate performance of the Contractor identified on page two.

This form contains a series of evaluation elements and questions for you, as the evaluator, to provide an evaluation of the contractor’s performance. Using the rating level definitions below, please provide a rating level for each element that best describes the contractor’s performance.

Please respond to each question by answering yes or no and provide an explanation as appropriate.

Please provide frank and concise comments in your evaluation and assessment of contractor’s performance. In addition to responding to the questions for the listed contract, please provide other information of contractor’s performance for similar contracts performed by the contractor for your organization.

Rater Information. After completing the questionnaire provide the requested rater information and sign/date the survey.

Exceptional

The contractor’s performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good

The contractor’s performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory

The contractor’s performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

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

Unsatisfactory

The contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problems for which the contractor’s corrective actions appear or were ineffective.

I. CONTRACT IDENTIFICATION:

C. DESCRIPTION OF CONTRACT

D. RELEVANCE OF WORK

II. IDENTIFICATION: (NAME OF PERSON AND AGENCY OR COMPANY COMPLETING

THE QUESTIONNAIRE)

III. PAST PERFORMANCE EVALUATION:

A. QUALITY OF PRODUCT OR SERVICE. Compliance with contract requirements, technical excellence of proposed supply items and service(s), furnished documents and reports in an accurate and timely manner.

[ ] Exceptional [ ] Very Good [ ] Satisfactory [ ] Marginal [ ] Unsatisfactory

Comment:

Was consideration received or monetary amount withheld for non-conforming supplies/services or late deliveries against this contract? Yes ____ No ____

If yes explain:

Was any part of the contract terminated or in litigation? Yes ____ No ____

If yes explain:

Did the firm comply with all environmental aspects of the contract? Yes ___ No ___

Additional Explanation:

B. TIMELINESS OF PERFORMANCE. Met service(s) performance times and did not receive any cure and/or show cause notices or have numerous complaints.

[ ] Exceptional [ ] Very Good [ ] Satisfactory [ ] Marginal [ ] Unsatisfactory

Comment:

Describe any corrective actions initiated to solve any of the above problems.

C. COST CONTROL. Pricing was considered Satisfactory and reasonable, no excessive or unreasonable claims and submits proper invoices.

[ ] Exceptional [ ] Very Good [ ] Satisfactory [ ] Marginal [ ] Unsatisfactory

Comment: Performance meets contractual requirements. Contractor submits timely and proper invoices. No claims have been filed to date.

[ ] Exceptional [ ] Very Good [ ] Satisfactory [ ] Marginal [ ] Unsatisfactory

Comment:

E. BUSINESS RELATIONS. Effective Management, reasonable and cooperative behavior and overall business-like concern for the interests of the customer, effective Contractor recommended solutions to problems.

[ ] Exceptional [ ] Very Good [ ] Satisfactory [ ] Marginal [ ] Unsatisfactory

Comment:

A. ____ They were an EXCEPTIONAL firm in every respect. Problems were solved in a spirit of teamwork. Quality work, timely actions and complete documentation were routinely achieved. We would unhesitatingly do business with the firm again.

B. ____ They were a VERY GOOD firm who met the requirements of the contract and exceeded some to the Government’s benefit. Problems were effectively resolved by the contractor. We would do business with the firm again.

C. ____ They were a SATISFACTORY firm who met the minimum requirements of the contract. Performance deficiencies improved when identified. An aggressive inspection program was required to ensure compliance. We would do business with the firm again.

D. ____ They were a MARGINAL firm who barely met the minimum requirements of the contract. We have serious doubts about doing business with this firm again.

E. ____ They were an UNSATISFACTORY firm who did not meet the requirements of the contract. We would not want to do business with this firm again under any circumstances.

EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION ON THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF EVALUATOR PRINTED NAME OF EVALUATOR