Past_Performance_Questionnaire.pdf

Attachment A

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: ____________________ Telephone Number: __________________

Address: __________________________ Fax Number: ________________________

________________________ Point of Contact: _____________________

______________________ Email: _____________________________

Project Title and Brief Description of Work: ___________________________________

Contract Number Provided by Offeror: ___________________ Dollar Amount: __________*

Contract Period or Dates of Performance Provided by Offeror: ________________________*

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. E-MAIL COMPLETED SURVEY FORM TO:

Kiesha Campbell th and C Streets, SW

Office of Acquisitions

Bureau of Engraving and Printing

Washington, DC 20228

E-mail: kiesha.campbell@bep.gov

*Please provide your timely response by 3:30pm on 24 August 2015.

mailto:kiesha.campbell@bep.gov

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE

PROVIDE A NARRATIVE EXPLANATION FOR YOUR RATINGS.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements.

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

does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Followed approved quality control plan.

4. Provided effective quality control and/or inspection procedures to meet contract requirements.

5. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

The contractor: E G S M U N

6. Provided timely resolution of contract discrepancies.

7. Was responsive to contract changes.

8. Paid subcontractors/suppliers in a timely manner.

9. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

10. Would you award another contract to this contractor? If not, explain in “remarks.”

YES/NO

Remarks:______________________________________________________________________