Exhibit 5 - Past and Present Performance Questionaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

PSYCHOLOGICAL ASSESSMENT SUPPORT SERVICES

H92239-20-R-0005

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL

NOT BE RELEASED TO THE OFFEROR.

SECTION 1: CONTRACT IDENTIFICATION

(to be completed prior to mailing or faxing to the respondent)

A. Contractor's Name:

B. Contract number:

C. Contractor's Role in the contract identified above: Prime: Yes

No

Subcontractor to Prime? If Yes, who?

D. Cage Code:

E. Contract type:

F. Was this a competitive contract? Yes No G. Period of performance:

H. Initial contract cost: $ I. Current/final contract cost: $ J. Reasons for differences between initial contract cost and final contract costs:

K. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

(to be completed prior to mailing or faxing to the respondent)

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other

Commands:

SECTION 3: EVALUATOR IDENTIFICATION

(to be completed by the respondent)

A. Evaluator's name:

B. Evaluator's title/role:

C. Evaluator's phone/fax number:

D. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

(to be completed by the respondent)

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL: Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD: Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY: Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL: Performance does not meet some contractual requirements. The contractual performance 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.

U UNSATISFACTORY: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE: Did not apply to this acquisition; or, questionnaire respondent has no knowledge of, and/or did not observe, the contractor’s performance in this area.

Program Management E V S M U N/A

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

Understand/complied with customer objectives and technical requirements and regulations

Contractor implemented responsive/flexible processes to improve quality and timeliness of support

Effectiveness in scheduling and maintaining instructor ratios

Technical Performance E V S M U N/A

Perform to standards of instruction for medical courses and the Program of Instruction

Produced highly effective students with a variety of skills

Perform to standards of quality control program and adherence to contract quality assurance requirements

Perform to standards of implementing current standard practices and specifications

Employee Retention/Attraction E V S M U N/A

Ability to hire/apply a highly qualified workforce

Ability to retain a highly qualified workforce

Maintain qualifications, certifications and clearances on all Contractor personnel

1. Please discuss each and every response for which you indicated a M (Marginal) or US (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

2. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes No

Default Convenience Pending Terminations

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

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs? Yes or No

Please provide any additional comments concerning this contractor’s performance in a separate document.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

RETURN YOUR COMPLETED QUESTIONNAIRE TO, HQ UNITED STATES ARMY SPECIAL OPERATIONS

COMMAND, DCSC, BLDG E2929 DESERT STORM DRIVE, FORT BRAGG, NC 28310, ATTN: BRIAN GILMORE, EMAIL: brian.gilmore1@socom.miland CC gail.williams@socom.mil mailto:jennifer.payne@socom.mil

PAST PERFORMANCE QUESTIONNAIRE