FCHS2_Section_J_Attachment_3_Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY 1

PAST PERFORMANCE QUESTIONNAIRE

1. Contractor Name:

Role on Project:

2. Contract Number:

3. Contractor Address: 4. Contract Type:

☐ Firm Fixed Price

☐ T&M/LH

☐ Cost Reimbursement ☐ Other (Please Specify):

5. Procuring Agency/Company Name: 6. Agency/Company POC:

Phone:

Email:

7. Period of Performance: 8. Dollar Amount of Award: $

Annual Amount: $

Total Dollar Value w/ Mods:$

9. Title of Contract:

10. Description of Contract Service/Scope of Contract:

11. Complexity of Work:

FOR OFFICIAL USE ONLY 2

NOTE: Please use adjectival ratings from attached sheet.

12. Evaluation Factor 13. Comments (Mandatory, Attach additional sheets, if necessary.) 14. Rating

a. Quality of Work

b. Personnel

c. Cost/Budget Control

d. Customer Satisfaction

e. Timeliness of Performance/Deliverables

f. Business Relations

g. Overall Performance

15. Would you select this contractor again? Please explain. (Attach additional sheet if necessary.)

16. Name:

Date:

17. Title:

Definitely Probably Definitely Not

FOR OFFICIAL USE ONLY 3

PAST PERFORMANCE RATING GUIDELINES

Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, and Exceptional. Use the following instructions as guidance in making these evaluations. Please use the comments area on the preceding form to justify the rating given.

Ratings Quality of Work/ Personnel/Service

-Compliance w/contract requirements -Accuracy of reports -Appropriateness of personnel -Technical excellence

Cost/Budget Control

-Within budget -Current, accurate, complete billings -Relationship of negotiated costs to actual -Cost efficiencies -Change orders issued

Customer Satisfaction

Customer Satisfaction is a measure of how products and services supplied by a company meet or surpass customer expectations.

Timeliness of Services/Deliverab les

-Met interim milestones -Reliable -Responsive to technical direction -Completed on time

Business Relations

-Effective Mgmt -Business like correspondence -Responsive to contract reqmnts -Prompt notification of problems -Reasonable/ cooperative -Flexible -Pro-active

Unsatisfactory Nonconformances are comprising the achievement of contract reqmnts

Cost issues are comprising performance

1 – Very Unsatisfied

Delays are compromising achievement of contract reqmts

Response is not effective

Marginal Nonconformances require major agency resources to ensure achievement of contract reqmnts

Cost issues require major agency resources to ensure achievement of contract reqmnts

2 – Somewhat Dissatisfied

Delays require major agency resources to ensure achievement of contract reqmnts

Response is marginally effective

Satisfactory Nonconformances do not impact achievement of contract reqmnts

Cost issues do not impact achievement of contract reqmnts

3 – Neither Satisfied Nor Dissatisfied

Delays do not impact achievement of contract reqmnts

Response is usually effective

Very Good There are no quality problems/issues, and the contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government

There are no cost management issues and the Contractor has exceeded the contract requirements, achieving cost savings to the Government.

4 – Somewhat Satisfied

There are no delays Response to inquiries and/or technical, service, administrative issues are effective.

Exceptional The contractor has demonstrated an exceptional performance level that was significantly in excess of anticipated achievements and is commendable as an example for others. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

The contractor has demonstrated an exceptional performance. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Exceptional".

5 – Very Satisfied The contractor has demonstrated an exceptional performance level.

It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

The contractor has demonstrated an exceptional performance level.

It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".