Section_J _Attachment_11 _PP_Questionnaire_(table).docx

ATTACHMENT 11: PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Reference Contractor’s Name:

Telephone Number:

Address:

Fax Number:

Street

Point of Contact:

City

CAGE Code:

State

Zip

(The government enters the following information based on list of references provided by the Offeror. The Offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work:

Contract Number Provided by Offeror:

Dollar Amount:

Contract Period or Dates of Performance Provided by Offeror:

Contractor performed as the: Prime Contractor, Subcontractor, and/or Key Personnel?

Note: If Offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Please provide the following information for the respondent completing this questionnaire:

Name:

Position / Role on Contract:

Address:

Agency:

Street:

Telephone Number:

City:

Email Address:

State:

Fax Number:

Zip:

C. IF FAXING YOUR RESPONSE, FAX COMPLETED SURVEY FORM TO: 402-294-0430. Please call Mr. Wayne Manke at (402) 232-6571 to advise him of the fax.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, VG, S, M and U) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF E, M, or U.

QUESTIONNAIRE

CONTRACTOR’S NAME:

CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

M3.2.2.2.2 Management Approach

OVERALL

For Government Contracts Only: Has this contract been or will it be partially or completely terminated for default or convenience or are there any pending terminations?

Yes

Default?

Convenience?

Pending Terminations?

No

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

NARRATIVE SUMMARY

Please discuss each and every response for which you indicated E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions above or if you would like to elaborate on anything else that might be considered significant (use additional sheets, if necessary).

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

End of questionnaire.

RFP FA4600-14-R-0017

Sect J, Attachment 11