HC1047-16-R-4008_-_Attachment_4_-_Past_Performance_Questionnaire.docx

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

SECTION I: CONTRACT IDENTIFICATION

1. Contractor: ________________________________________________________________

2. Cage Code of contractor contract was awarded to: _________________________________

3. Contract number and task order, if applicable: ____________________________________

4. Contract type (e.g., firm fixed price, cost plus, etc.): _______________________________

5. Was this a competitively awarded contract? Yes _____ No _____

6. Period of performance: ______________________________________________________

7. Initial contract cost: $____________________________

8. Current/final contract cost: $______________________

9. Reasons for differences between initial contract cost and final contract cost: ___________________________

10. Description of products/service provided:________________________________________ ______________

11. Geographic description of services under this contract, e.g., local, nationwide, worldwide, etc.: ________________________________________________________________________________________

SECTION II. EVALUATOR AND AGENCY IDENTIFICATION

A. Agency (customer) name: __________________________________________________________________ B. Evaluator's name and title: __________________________________________________________________ C. Evaluator's phone number and email address: ___________________________________________________ ________________________________________________________________________________________ D. Number of Years Evaluator Worked on Subject Contract: __________________________________________

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

Circle your response, and/or provide written responses, when applicable.)

1. Technical Performance

a. Did the contractor meet the technical requirements of the PWS? Yes No

If no, please explain: _______________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________

b. What was the overall quality of the contractor’s performance? ____________________________________

2. Program Management

a. Did the contractor effectively manage and direct the contract? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

b. Did the contractor maintain good business relations with the agency? Yes No If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

3. Transition/Phase-In

Did the contractor smoothly transition its resources and personnel? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

4. Employee Staff and Retention

a. Did the contractor recruit, hire, train and retain a qualified workforce with the appropriate skill levels during the term of the contract, and maintain a low turnover rate? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

b. Did the contractor replace departing personnel with employees of the same quality and skills and do so with minimal disruption to contract performance? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

5. Price/Cost Performance

a. Did the contractor effectively forecast, manage and control price/costs? Did it alert the agency of unforeseen costs before they occurred? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

b. Did the contractor meet forecasted costs and perform within contract price/costs? Yes No

If no, please explain: _______________________________________________________________________ _________________________________________________________________________________________

For the chart below and question 6, please use the following performance levels to answer the question:

EXCEPTIONAL (E) (Blue) - During the contract period, contractor performance meets or met contractual requirements and exceeds or exceeded many to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VERY GOOD (VG) (Purple) - During the contract period, contractor performance meets or met contractual requirements and exceeds or exceeded some to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective

SATISFACTORY(S) (Green) – During the contract period, contractor performance meets or met contractual requirements. The contractual performance of the element or sub-element being assessed contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MARGINAL (M) (Yellow) – During the contract period, contractor performance does not or did not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

UNSATISFACTORY (U) (Red) – During the contract period, contractor performance does not or did not meet most contractual requirements and recovery in a timely manner is not likely. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

YES/NO

6. What is your OVERALL level of satisfaction with the contractor’s performance?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Evaluator’s Signature Date

SECTION IV. RETURN OF COMPLETED FORM

Please return your completed form via email to:

jestina.n.shearin.civ@mail.mil and jacelyn.e.stanton.civ@mail.mil

SAMPLE QUESTIONNAIRE COVER LETTER

LETTERHEAD

(Date)

FOR OFFICIAL USE ONLY

The Defense Information Systems Agency (DISA) is in the process of selecting a contractor for Cost/Business Analysis and Financial Management Support. This contract will provide contractor support for cost estimation, business analysis, financial analytical services and budget formulation. The contractor will assist in the development of cost management activities for Defense Information System Agency (DISA) programs. The contractor will perform various budget functions involving the formulation, and assisting with justification of budgets for organizations, programs or projects. The contractor will also provide services that will aid in budget estimates, program and resource requirements, and appropriation requests. They will analyze trends and developments in DISA's planning, programming, budget and execution process concerning appropriations, funding priorities and workload management which supports overall program operations. The Request for Proposal number is HC1047-16-R-4008.

One of the considerations in proposal evaluation is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. We depend on information received from agencies such as yours, which have had firsthand experience with an offeror, for the evaluation of the offeror's performance on those contracts.

Our areas of interest in the offeror are summarized in the enclosed questionnaire. As discussed in our initial phone contact with your office, our schedule is extremely tight and we need your written response no later than _______ calendar days after your receipt of this letter. To assist you in preparing your response and expediting your reply, the questionnaire may be filled out by hand and emailed to jestina.n.shearin.civ@mail.mil and jacelyn.e.stanton.civ@mail.mil. The Subject Line in the email shall include “Source Selection Sensitive, PP Response for HC1047-16-R-4008.”

Please call _______________at XXXXX-XXXX prior to email or if you have any questions. Your completed questionnaire will become a part of the official contract file. Your help is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Signature

1 Atch Questionnaire