HC1047-17-R-0001_-_Attachment_5__-_Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

HC1047-17-R-0001

SAMPLE QUESTIONNAIRE COVER LETTER

LETTERHEAD

(Date)

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

The Defense Information Systems Agency (DISA) is soliciting proposals for “Systems Engineering Technology and Innovation (SETI)” services. SETI will be an overarching approach for fulfilling requirements for developmental information technology (IT) engineering support services across the Department of Defense (DoD) with an emphasis on innovation.

One of the considerations in proposal evaluations is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. The Government depends 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 contract(s).

The areas of interest for the Government are summarized in the questionnaire below. Questionnaires should be completed and returned to the offeror for submission with their proposal. Proposals are due _________ so we kindly ask for your response by ________ so it can be included in the proposal submission.

Please complete all sections of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone number. Use the rating scale and definitions found in the questionnaire to rate each performance element. Please sign the questionnaire.

The Government encourages comments. The last page may be used if additional space is needed for comments.

Clear handwritten responses are sufficient.

Thank you for your time and participation.

Sincerely, NAME

Title

PAST PERFORMANCE QUESTIONNAIRE

SECTION I: CONTRACT IDENTIFICATION (To be filled out by Offeror)

1. CONTRACTOR’S NAME & ADDRESS:

2. CAGE CODE OF PRIME CONTRACTOR:

3. CONTRACT NUMBER (include task number if applicable):

4. AWARD ENVIRONMENT:

COMPETITIVE NON-COMPETITIVE

5. CONTRACT TYPE:

FIRM FIXED PRICE COST + FEE

FIXED PRICE + FEE LABOR HOUR

COST or COST SHARING TIME & MATERIALS

OTHER ___________________

6. PERIOD OF PERFORMANCE (including options):

7. INTIAL CONTRACT VALUE (including options):

8. CURRENT/FINAL CONTRACT VALUE

(including options):

9. REASONS FOR DIFFERENCES BETWEEN INITIAL CONTRACT VALUE AND FINAL CONTRACT VALUE:

10. DESCRIPTION OF PRODUCTS/SERVICE PROVIDED:

11. LOCATION SERVICES PROVIDED (local, nationwide, worldwide, etc.):

SECTION II. EVALUATOR AND AGENCY IDENTIFICATION (To be filled out by the Evaluator)

1. AGENCY (CUSTOMER) NAME:

2. EVALUATOR NAME & TITLE:

3. EVALUATOR CONTACT INFORMATION:

TEL NO.:

E-MAIL:

4. NUMBER OF YEARS EVALUATOR

WORKED ON SUBJECT CONTRACT:

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

Adjectival ratings definitions to be used in your response:

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.

No Knowledge of This Element (NA): No knowledge of this element or does not apply to meeting contractual requirements

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

PAST PERFORMANCE ELEMENT

RATING

E VG S M U NA

1. Contractor demonstrated a thorough understanding of technical requirements of the contract/task.

Comments:

2. Contractor managed and directed resources (i.e. personnel, subcontractors, equipment, etc.) effectively. Contractor met or exceeded program cost, schedule, and performance goals.

Contractor forecasted, managed, and controlled contract cost/price.

Contractor invoiced appropriately and in a timely manner.

3. Contractor recruited, hired, and trained a qualified workforce with the appropriate skill levels to perform the required work.

4. Contractor retained a qualified workforce with the appropriate skill levels and maintained a low turnover rate. Contractor replaced departing personnel with employees of the same quality and skills with minimal disruption to performance.

5. Contractor developed and implemented innovative processes and methodologies. Contractor improved efficiencies through innovative processes and approaches.

6. Contractor anticipated, identified, and resolved problems effectively and in a timely manner. Contractor suggested alternative approaches to unresolved problems. Contractor identified and reduced unanticipated risks.

7. Contractor provided accurate, complete and high quality performance and deliverables.

8. Contractor developed realistic schedules and met established schedules and delivery dates.

9. Contractor was responsive to contract changes. Contractor complied with the terms of the contract.

10. Contractor cooperated with Government personnel after award.

11. Contractor provided an innovative solution.

RATING

YES NO

12. Contractor was issued a cure or show cause notice under the referenced contract. If yes, please explain the outcome.

Comments:

13. The contractor is rated in Past Performance Information Retrieval System (PPIRS).

14. I would recommend award to this contractor again.

OVERALL RATING

EXCEPTIONAL

(E) (Blue)

VERY GOOD

(VG) (Purple)

SATISFACTORY

(S) (Green)

MARGINAL

(M) (Yellow)

UNSATISFACTORY

(U) (Red)

EVALUATOR’S SIGNATURE Date

Sincerely,