Attachment_6_Past_Performance_Questionnaire.pdf

Past Performance Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please return the completed

Questionnaire within 3 days. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Fax Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

Exceeds Contractual Requirements (Explanation must be provided in Comments field below) Meets Contractual Requirements

Failed to Meet Contractual Requirements (Explanation must be provided in

Comments field below)

Comments:

Exceptional (Explanation must be provided in Comments field below)

Satisfactory

Unsatisfactory (Explanation must be provided in Comments field below)

Exceeds Contractual Requirements (Explanation must be provided in Comments field below) Meets Contractual Requirements

Failed to Meet Contractual Requirements (Explanation must be provided in

Comments field below)

1. Compliance of Products, Services, Documents, and Related Deliverables to Specification

Requirements and Standards of Good Workmanship.

2. Maintain Program Execution within Costs

3. Timeliness of Performance for Services and Product Deliverables, including the

Administrative Aspects of Performance.

Extremely Satisfactory (Explanation must be provided in Comments field below)

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

4. Ability to Resolve Technical Problems Quickly and Effectively

5. Commitment to Customer Satisfaction and Business-like Concern for its Customers’

Interest.

F. Overall Satisfaction.

G. General Comments. Provide any other relevant performance information.

H. Other Information Sources. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number

Address:

Fax Number:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to Victor J. Stamps, Contracting Officer, by email:

Victor.J.Stamps@usdoj.gov or fax 816-467-1982.

Thank you for your assistance.

I. Respondent Identification. Please provide the following information:

mailto:Victor.J.Stamps@usdoj.gov