Att_5_Past_Performance_Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION: D17PS00139

I. COMPLETION OF QUESTIONNAIRE

The information obtained from this questionnaire will be utilized to evaluate the past and present performance of offerors submitting proposals in response to the Department of Interior, on behalf of Defense Advanced Research Projects Agency Strategic Technologies Office, solicitation for advisory and assistance services, more specifically, scientific, engineering, and technical assistance (SETA) program support. Complete all sections of the identifying information and attached past performance questionnaire. The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s). Responses will be treated as source selection sensitive information. Comments are encouraged and would be appreciated. The last page may be used if additional space is needed for comments. Clear handwritten responses are sufficient. This information shall be submitted no later than the proposal due date. Return the completed questionnaire by e-mail or delivered to the address below:

Email to: Rachelle_Colon-Serna@ibc.doi.gov

Mail: Department of the Interior Interior Business Center Acquisition Services Directorate 354 South Highway 92 Sierra Vista, AZ 85635

II. EXPLANATION OF CODES

PERFORMANCE LEVEL

PLEASE COMPLETE THE FOLLOWING IDENTIFYING INFORMATION AND PAST PERFORMANCE QUESTIONNAIRE:

CONTRACTOR IDENTIFICATION

CONTRACTOR’S NAME & ADDRESS:

DESCRIPTION OF REQUIREMENT (SCOPE)/COMPLEXITY:

CONTRACT NUMBER:

TOTAL CONTRACT VALUE (INCLUDING OPTIONS):

|_| TIME & MATERIAL

|_| COMPETITIVE |_| NON-COMPETITIVE

|_| SET-ASIDE |_| SEALED BID

|_| NEGOTIATED

DEGREE OF SUBCONTRACTING TEAMING:

EVALUATOR INFORMATION

YOUR NAME & TITLE

YOUR ORGANIZATIONAL ADDRESS

PHONE.:

FAX:

EMAIL:

Relation to Program (ie. Contracting Officer, Contract Specialist/Administrator, Contracting Officer’s Representative, etc.):

TERMINATION HISTORY

1. Has this contract been partially or completely terminated for default or convenience?

YES |_| NO |_| DEFAULT |_| CONVENIENCE |_|

If yes, explain (e.g., inability to meet cost, performance, or delivery schedules).

2. Are there any pending terminations?

YES |_| NO |_|

If yes, explain and indicate the status.

ASSESSMENT ELEMENTS

Place an “X” in the appropriate box next to the letter for each item on the questionnaire. Narrative statements are vital. Please provide a supporting narrative for each area. Attach additional pages if there is insufficient space in the comment space.

1. QUALITY OF PRODUCT/SERVICE (e.g., quality of information technology support services, phase-in support, reports, etc.) Did the contractor provide qualified personnel, necessary resources, and quality control? Did the contractor meet established guidelines and policies for safety and security? Did the product/service meet the required level of quality?

E |_| V |_| S |_| M |_| U |_| N |_|

2. SCHEDULE (i.e., Did the contractor provide adequate staffing to meet workload requirements and emergency restoration requirements and was the work performed in a timely manner and in accordance with the requirement?)

E |_| V |_| S |_| M |_| U |_| N |_|

3. COST CONTROL (e.g., Were obligations performed within the ceiling price in the contract, were contractor requests for employee overtime reasonable, were proposals for equitable adjustments and special projects reasonable, etc.)

E |_| V |_| S |_| M |_| U |_| N |_|

4. BUSINESS RELATIONS (e.g., were contractor personnel promoting a strong working relationship with the Government, did the contractor adequately address and make efforts to resolve issues/problems concerning site employees, did the contractor show initiative, were contractor personnel courteous and responsive, did the contractor interface effectively with your staff, etc.)

E |_| V |_| S |_| M |_| U |_| N |_|

5. MANAGEMENT OF KEY PERSONNEL (e.g., did the contractor provide the site manager/leader or key employees with the necessary resources and support to adequately perform their work, did the contractor adequately address and make efforts to resolve issues/problems concerning the site manager/leader or key employees, was the contractor able to solve contract performance problems without extensive guidance from government counterparts, etc.)

E |_| V |_| S |_| M |_| U |_| N |_|

6. Did the contractor adhere to its technical and management approach?

YES |_| NO |_|

If no, explain what was different.

7. Please comment on any other contractor information you consider relevant to this evaluation.

8. Identify the contractor’s overall strengths and weaknesses.

9. If there were problems, did the contractor act promptly to resolve them? How affective was the contractor’s corrective action?

10. Given the choice, would you award to this contractor again? YES |_| NO |_|

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104

D17PS00139 Attachment 5