PAST PERFORMANCE QUESTIONNAIRE.doc

Attachment D

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and mail, scan to email or send by facsimile [FAX 202-401-6075]to: Jezreel Sweat

301 7th St., SW Rm 7107

Washington, DC 20407-0001 Attn: Jezreel Sweat, Contract Specialist Jezreel.Sweat@gsa.gov

Desired Response Date: 5 May 2011

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY PAST PERFORMANCE REFERENCE AT EVALUATING ORGANIZATION

8. EVALUATION: a. NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. PHONE NUMBER: c. FAX NUMBER:

d. MONTHS OF PERFORMANCE MONITORED: e. DATE: f. SIGNATURE:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

O = Outstanding

E = Excellent A = Adequate

M = Marginal P = Poor

N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards). Evaluate the effectiveness of the contractor's overall quality control procedures and safety program or efforts.

O E A M P N/O

B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project. Evaluate the contractor's overall technical competence.

A M P N/O

C. Schedule – Assess the timeliness of contractor against the schedule of activities. Evaluate the contractor's responsiveness to contract, program an/or schedule changes.

A M P N/O

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract. Assess the contractor's ability to overcome technical problems, labor issues, and/or other performance difficulties

A M P N/O

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

A M P N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”. Evaluate the contractor's overall commitment to quality performance and customer satisfaction. Evaluate the contractor's cooperation and willingness to work as a team (with your personnel, other contractors, etc.)

A M P

G. Personnel - Assess the availability, adequacy, and suitability of the contractor's staffing for the work required. Assess the quality and stability of the contractor's workforce.

O E A M P M/O

H. MANAGEMENT - Assess the effectiveness of the contractor's on-site management and supervision including the contractor's ability to plan and conduct operations in the most cost effective manner.

O E A M P M/O

I. Overall Assessment.

A M P

If an Award Fee contract, what was the average Award Fee % earned?

DATE LAST REVISED – FEBRUARY 2009