ATTACHMENTD..pdf

ATTACHMENT D

PAST PERFORMANCE CONTACT INFORMATION SHEET

AND QUESTIONNAIRE (FCC14R0012)

PART I – Past Performance Contact Information (FCC14R0012) [to be completed by Offeror]

Instructions: The Offeror shall complete Part I of this Attachment D for each past performance reference. The Offeror shall arrange with its reference for completion of this form and return it to the Offeror in sufficient time for the Offeror to incorporate the completed form in its proposal. The Offeror shall include a copy of this form as completed in Vol. I, Part 1.F of its proposal.

Offeror 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) _____________

Type & Extent of Subcontracting:

Description of Services Provided:

Part II: Past Performance Questionnaire Contact (FCC14R0012) [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, FCC14R0012.

The offeror (or subofferor) on this acquisition, 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 a completed copy of this questionnaire to the requesting company in a sealed company envelope.

Answers to Questions 1-3 are for general information and are needed to place the remaining questionnaire answers in context. For questions 4- 16 please provide a narrative response and a rating. Detailed narrative responses serve as the most important guide to future performance. Therefore, FCC regards your narrative responses as the most important aspect of this questionnaire and would deeply appreciate your time in preparing those responses. Please also rate the offeror on a scale of 1-10, where one (1) represents a completely unsatisfactory experience and ten (10) an outstanding experience, with the offeror with respect to the subject of the question. 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 offeror 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?

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

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?

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

7. What were your 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 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?

15. If the contract required the Contractor to develop an IT or telecommunications platform, what were your experiences with the Contractor’s ability and method of development and implementation?

16. If the contract required the Contractor to staff and manage an operations and maintenance function or provide administration services, what were your experiences with the Contractor’s expertise and ability in developing and undertaking such activities?