13. Past Performance Questionnaire.pdf

FA3020-10-R-0041

Attachment 13

CONTRACTOR PERFORMANCE ASSESSMENT QUESTIONNAIRE

5 Sep 10

The purpose of this questionnaire is for you to provide Sheppard Air Force Base with information concerning the performance of the offeror/contractor in question. Sheppard AFB understands that this offeror/contractor has performed similar services for you/your office and requests your comment.

Name of Offeror/contractor:

Contract Name and Number: Contract Value:

Contract Type:

Brief Description of Contract Item or Service:

Name of Person Completing this Questionnaire:

Phone Number: Position:

Name of Government Agency:

Criteria. Request supporting narrative be provided for all ratings except for Satisfactory (S). For any Marginal (M) or Unsatisfactory (U) rating, please explain details. Also, please explain corrective actions instituted and whether or not the problem was corrected, etc. Please enter your comments in the space provided with each question.

EXCEPTIONA

L (E)

VERY

GOOD

(V)

SATISFACTOR

Y (S)

MARGINA

L

(M)

UNSATISFACTOR

Y

(U) Performance met all contract requirements and exceeded many to the Government’s benefit.

Problems, if any, were negligible and were resolved in a timely, highly effective manner

Performance met all contract requirements and exceeded some to the Government’ s benefit.

There were a few minor problems which the contractor resolved in a timely and effective manner

Performance met all contract requirements.

There were some minor problems and corrective actions taken by the contractor were satisfactory

Performance met all contract requirement

s. There were some major problems and corrective actions taken by the contractor were not always satisfactory

Performance did not meet contractual requirements. There were serious problems, and the contractor’s corrective actions were ineffective

FA3020-10-R-0041

Attachment 13

NOTE: At a minimum, please complete Item #7 below.

Not Applicable – (N/A) – No performance record identifiable

Response

1. How would you rate the quality of service provided to include customer satisfaction?

Supporting narrative: (See above criteria)

E V S M U N/A

2. How would you rate the abilities/quality of service provider’s professional qualifications?

3. How would you rate service provider’s response time?

4. How would you rate overall customer satisfaction with the service provider’s performance?

Supporting narrative: (see above criteria)

5. How would you rate the service provider’s cooperativeness and receptiveness to government concerns affecting performance requirements?

6. Were any discrepancy reports submitted to the service provider due to quality deficiencies?

7. OVERALL RATING: Based on your observations, provide an overall rating for this contractor’s performance in executing your requirement(s).