Attachment_-_FCC_ISAS_PP_Questionnair.pdf

ATTACHMENT

PAST PERFORMANCE CONTACT INFORMATION SHEET

AND QUESTIONNAIRE (SOL #FCC13R0006 )

PART I – Past Performance Contact Information (SOL ) [to be completed by Offeror]

Instructions: The Offeror shall complete Part I of this Attachment for each past performance reference. The Offeror shall include a copy of Part I of this form as completed under

FCC13R0006 of its proposal. The Offeror shall forward this form (with a completed Part I) to each of its references for completion, with instructions to forward the completed questionnaire to the Contracting Officer (NOT BACK TO THE OFFEROR) before the time set for receipt of proposals. The completed questionnaires should be forwarded by email directly from the

Offeror’s reference to _Sunny Diemert at Sunny.Diemert@fcc.gov.

Offerer Information:

Name of Offeror Providing Services: ____________________________________________

Address: ____________________________________________________________________

Past Performance Reference Information:

Name of Agency/Organization Receiving Services:

Address: _____________________________________________________________________

Telephone: _________________________ FAX: _____________________________

Contract Information:

Contract Number: _____________________ Dollar Value (Annual): _______________

Performance Period: ___________________ Performance Location: _______________

Type of Contract (Check all that apply):

Fixed Price ______ Cost Reimbursement ______ Other (specify) _________________

Negotiated ______ Sealed Bid ______ Competitive ______ Non-Competitive _______

Basis of Payment:

Labor/Equipment Hours _______ Other (specify) _____________ mailto:Sunny.Diemert@fcc.gov

Type & Extent of Subcontracting: ________________________________________________

Description of Services Provided: ________________________________________________

Part II: Past Performance Questionnaire Contact (SOL )[to be completed by

Agency or Organization Receiving Services]

Instructions: The following questionnaire will be considered in a Federal Communications

Commission competitive acquisition being conducted among eligible Offerors. The Offeror who provided this questionnaire to you wishes to have your responses considered as part of the

FCC’s past performance evaluation in the acquisition. Please complete the questionnaire and provide an electronic copy of it to _Sunny Diemert by 4PM EST on August 23,2013 at

Sunny.Diemert@fcc.gov

Answers to Questions 1-3 are for general information and are needed to place the remaining questionnaire answers in context. For questions 4-15, please provide a narrative response and a rating. Please rate the Contractor on a scale of 1-10, where one (1) represents a completely unsatisfactory experience and ten (10) represents an outstanding experience, with the Offeror with respect to the subject of the question. We would very much appreciate narrative elaboration for each question, but we would especially appreciate narrative elaboration for ratings that are very low (1-3) or very high (8-10). If you have no experience with the

Contractor on the identified contract with respect to the question, select N/A.

1. Please identify the individual completing this questionnaire.

Name:

Title:

Present Employer:

Telephone Number:

E-Mail Address:

2. What was your relationship to, and role with respect to, the contract identified in Part I above?

3. Is the contract accurately described?

mailto:Sunny.Diemert@fcc.gov

4. What were you experiences with the quality of the services provided by this Contractor?

Please provide your narrative description if necessary:

Bold or Underline a Rating: 1 2 3 4 5 6 7 8 9 10 N/A

5. What were your experiences with the Contractor’s adherence to contract schedules, including the administrative aspects of performance?

6. What were you experiences with the Contractor’s overall ability to meet schedules for delivery of reports?

7. What were you experiences with the Contractor’s ability to meet any special requirements for expedited delivery or service?

8. What were your experiences with the Contractor’s conforming to contract requirements generally?

9. What were your experiences with the Contractor’s standards of professionalism?

10. What were your experiences with the Contractor’s record of forecasting and controlling costs and working with you to limit additional costs and, if you are a Government agency, to limit upward equitable adjustments to the Government’s price in the event of changes?

11. What were your experiences with the Contractor’s integrity and business ethics?

12. What were your experiences with the Contractor’s spirit of cooperation and fairness of business dealing with you?

13. What were your experiences with the Contractor’s commitment to your satisfaction as a customer and concern for your business interests?

14. What were your experiences with the Contractor’s reporting into Government databases to which it was obliged to report?

Please use continuation sheets if necessary for narrative responses.