EUS_Attachment_Two_(2)_-_Past_Performance_Questionnaire.pdf

Attachment Two (2) Past Performance Questionnaire Solicitation #: DOC52PAPT1500005

INSTRUCTIONS

You have been identified as a Past Performance Reference for the contractor indicated in Block 1 below.

This contractor is proposing on a U.S. Patent and Trademark Office (USPTO) acquisition for USPTO’s End User Support Services. We value your input and appreciate greatly your willingness to thoughtfully complete this questionnaire.

Block 1. Contractor Name:

Please complete the following steps (1) Fully complete the questionnaire and complete the signature page on page 5, (2) Submit the questionnaire to the Contracting Specialist via email for fax no later than the closing date and time of the RFQ submission due date of Sep 18, 2015, (3) Questionnaires should be submitted to Shellie Eaton (email: EUS15@uspto.gov or fax #: 571-273-5146). If you have questions, please contact our Contract Specialist, Shellie Eaton, at (571) 272-5146.

Please use the supplemental information section at the end of the questionnaire to expand on your ratings, making sure to identify your comments with the appropriate question number. You may expand on and more fully discuss any of the questions. Use extra pages as necessary. Negative responses may be referred to the contractor to permit rebuttal. Neither your name nor position within your organization will be divulged either during or after this survey has been completed.

Contract Information Contractor/Division:

Program Title:

Contract Number:

Contract Award Date: ____________________________________ Contract Completion Date:

Period of Performance:

Type of Contract:

Total Dollar Amount of Contract:

mailto:EUS15@uspto.gov

DESCRIPTION OF MAIN ELEMENTS OF WORK PERFORMED UNDER THE CONTRACT

The following are the definitions for the rating system being used:

5 - Excellent – No issues. Requirements were achieved within cost, on time, and in conformance with contract.

4 - Good – Issues did not impact achievement of requirements.

3 - Average – Issues required minor Agency resources to ensure achievement of requirements.

2 - Marginal – Issues required major Agency resources to ensure achievement of requirements.

1 - Unsatisfactory – Issues compromised the achievement of requirements.

QUESTIONNAIRE

(Please check the appropriate box for each rating factor)

QUALITY: N/A 5 4 3 2 1

Compliance with contract requirements, accuracy, appropriateness of personnel, technical excellence

CUSTOMER SERVICE: N/A 5 4 3 2 1

Satisfaction of end users, team approach with customer, positive customer feedback, courteous interactions, prompt responses

TIMELINESS OF PERFORMANCE: N/A 5 4 3 2 1

Reliable, responsive, completed on time, no penalties or liquidated damages assessed

BUSINESS RELATIONS: N/A 5 4 3 2 1

Effective Management, businesslike correspondence, flexible, prompt notification of problems, proactive, effective solutions

OVERALL EVALUATION: N/A 5 4 3 2 1

How would you rate the contractor’s overall performance?

WOULD YOU AWARD ANOTHER CONTRACT TO THIS VENDOR/CONTRACTOR?

YES _____ OR NO _____

INDICATE REASONS FOR YOUR RESPONSE (additional comments may be attached)

SUPPLEMENTAL INFORMATION

SIGNATURE PAGE

CUSTOMER ORGANIZATION

NAME AND ADDRESS

Evaluator’s Printed Name Title/Role (e.g., Program Manager, Contracting

Officer)

Evaluator’s Signature Date Phone

Please note the following regarding the confidentiality of your assessment:

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

QUESTIONNAIRE