Past_Performance_Questionnaire_H D.pdf

FA5682-15-R-0009 Attachment (1)

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

PRESENT AND PAST PERFORMANCE/EXPERIENCE INFORMATION

QUESTIONNAIRE

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

Contractor’s Name: ____________________ Telephone Number: ____________________

Address: __________________________ Fax Number: _________________________

__________________________ Point of Contact: ______________________

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 Sub-Contractor 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.

file:///D:/far/Far02.doc%23T2101 file:///D:/far/FAR03.DOC%23b3104

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. EMAIL COMPLETED SURVEY FORM TO: See Page 24, Paragraph 5.7 of the solicitation.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (A, U and

UNK) that most accurately describes the contractor’s performance or situation. PLEASE

PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF U.

Rating Definition

Acceptable (A) Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown

Unacceptable (U) Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

Unknown/Neutral

(UNK)

In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so spars that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the offeror shall be determined to have unknown past performance.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

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

* Please explain the circumstances of any “unsatisfactory” rating in the corresponding “Remarks” area of each item.

A U * UNK N/A

1. Rate how well the contractor provided adequate, competent and qualified personnel capable of meeting contract requirements throughout the performance period of the contract.

Remarks:

A U UNK N/A

2. Rate how timely and sufficient the contractor’s resources (manning levels, etc.) were/are to meet contract requirements (technical, management, and contractual).

3. Rate how well the contractor respond(s/ed) to and act(s/ed) on customer feedback.

4. Rate how well the contractor perform(s/ed) the terms of the contract within the contractually agreed price.

5. Rate how well the contractor demonstrate(s/d) a reasonable and cooperative business relationship with the Government’s Program

Management and Contract Management teams.

6. Rate how timely and effective the contractor’s responses to and resolution of problems were/are.

7. Rate how flexible, cooperative, and reasonable the contractor was/is in meeting mission requirements, particularly during short-notice mission changes.

8. Rate how innovative the contractor was/is in performing and resolving problems.

9. Rate how responsive the contractor’s quality program was/is in identifying, correcting, and preventing initial and recurring contract discrepancies.

10. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “Remarks.”

YES NO

11. Would you award another contract to this contractor? If not, explain in

“Remarks” below.

YES NO

Remarks:______________________________________________________________________