DTFH61-12-R-00057 Attachment 6.pdf

DTFH61-12-R-00057

Attachment No. 6

PAST PERFORMANCE QUESTIONNAIRE

Referencee Information: Provide the following information for the Organization that performed the referenced work:

Referencee Information:

Offeror’s (Prime Name: __________________________________________________________________

Referencee’s Name:______________________________________________________________________

Solicitation Number & Title:_______________________________________________________________

Organization/Person Providing the Reference Information: Provide the following information for the Organization and Person/Point of Contact (POC) providing the reference (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Reference Information:

Organization Name: _______________________________________________________________

Questionnaire Completion Date:___________________________________________________________

Name of Contact: _______________________________________________________________________

Contact Numbers: Telephone:_______________________Facsimile:_______________________

Organization/Office: _______________________________________________________________

Position Title: ______________________________________________________________________

Reference Project Information: Provide the following information about the referenced project.

Reference Project Information:

Customer Organization/Office: ________________________________________________________

Project Title: ______________________________________________________________________

POC Period of Involvement:_____________________________________________________________

Type of Contract:______________________________________________________________________ Start Period of Performance: Date: _____________________ Length_____________________

Contract Value: Initial____________________ Current____________________

PAST PERFORMANCE QUESTIONNAIRE

For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment lines may be used to provide any additional information deemed noteworthy).

High

Low

1.

QUALITY OF SERVICE: 5

3 2 1

This area deals with compliance of contract requirements, to include appropriateness of personnel and technical excellence.

2.

TIMELINESS OF PERFORMANCE: 5

This area deals with the contractors ability to meet milestones and delivery schedules, to include responsiveness to technical direction, completion of efforts on time including wrap-up and contract administration.

3.

PRICE/COST CONTROL: 5

This area deals with the contractors ability to control price/cost escalation during performance to include appropriate budgetary estimates, current/accurate/complete billings/invoices, relationship of negotiated costs to actual, claim submissions, cost efficiencies, and change order issues.

4.

CUSTOMER SATISFACTION: 5

This area deals with the contractors commitment to satisfaction and cooperative/reasonable businesslike behavior with own staff and customers to include: effective management, responsiveness to contract requirements, operates with honesty and integrity, prompt notification of problems, flexible and proactive qualities, effective contractor-recommended solutions, and effective subcontracting and teaming arrangements.

Comments (attach additional pages as necessary):

GENERAL INFORMATION: Please provide answers to the following questions.

1. Has the contractor ever been given a cure notice, show cause notice, suspension of progress payments, or other letters directing the correction of a performance problem; or has this contract been partially or completely terminated, or is there any pending termination actions?

( ) No ( ) Yes If yes: ( ) Default ( ) Convenience; and please explain:

2. Changes in contract dollar value throughout the life of the contract are/were attributable, for the most part, to:

( ) Government-issued change orders ( ) claims submitted by the contractor ( ) other Government actions ( ) other contractor actions (please explain below)

3. Based on this contractor’s overall performance, would you award this contractor another

Government contract?

( ) Yes ( ) No If no, please explain:

4. If any of the above responses are based on adverse past performance, have you discussed it with the contractor and has the contractor had an opportunity to comment?

( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain: