Past Performance Questionaire blank.docx

10.0 PAST/PRESENT PERFORMANCE QUESTIONNAIRE

When filled in this document is source selection sensitive information iaw FAR 2.101 and 3.104

SECTION 1: CONTRACT IDENTIFICATION

Contractor: _________________________________________________________________________

Cage Code of contractor contract was awarded to: _________________________________

Contract number: _______________________________________

Contract type: ______________________________

Was this a competitive contract? Yes _____ No _____

Period of performance: _________________________________________________________

Initial contract cost: $____________________________

Current/final contract cost: $_______________________________

Reasons for differences between initial contract cost and final contract costs:

Description of service provided: ____________________________________________________________________________________

SECTION 2. CUSTOMER OR AGENCY IDENTIFICATION

Customer or agency name: ____________________________________________________________________________________

Customer or agency description (if applicable): ____________________________________________________________________________________

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

SECTION 3. EVALUATOR IDENTIFICATION

Evaluator's name: ___________________________________________________________________________________

Evaluator's title: ___________________________________________________________________________________

Evaluator's phone/fax number: ___________________________________________________________________________________

D. Number of years evaluator worked on subject contract: _____________________

SECTION 4. EVALUATION

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

B BLUE/EXCEPTIONAL - The contractor's performance meets contractual requirements and exceeds many (requirements) to the Government's benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

P PURPLE/VERY GOOD- The contractor's performance meets contractual requirements and exceeds some (requirements) to the Government's benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

G GREEN/SATISFACTORY - The contractor's performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Y YELLOW/MARGINAL - Performance does not meet some contractual requirements. The contractual performance 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.

R RED/UNSATISFACTORY - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

SECTION 5. RELEVANT EXPERIENCE

Prior program management of all aspects of administration, management, and execution all logistical processes necessary to oversee up to 70 professionals with technical backgrounds at geograph-ically separated locations

Execution of prior marketing plan/process to attract superior research that has resulted in successful outreach and promotion as evidenced by meeting or exceeding pre-determined goals of the marketing plan/process.

Providing performance in a DoD environment

SECTION 5. EVALUATION

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

B BLUE/EXCEPTIONAL - The contractor's performance meets contractual requirements and exceeds many (requirements) to the Government's benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

P PURPLE/VERY GOOD- The contractor's performance meets contractual requirements and exceeds some (requirements) to the Government's benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

G GREEN/SATISFACTORY - The contractor's performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Y YELLOW/MARGINAL - Performance does not meet some contractual requirements. The contractual performance 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.

R RED/UNSATISFACTORY - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

SECTION 6: NARRATIVE SUMMARY

What were the contractor's greatest strengths in the performance of the contract?

What were the contractor's greatest weaknesses in the performance of the contract?

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.

Evaluator's Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

FA9550-11-R-0001

Attachment 3, FAR 52.212-1 5 July 2011