Attachment_1_PAST_PERFORMANCE_QUESTIONNAIRE-SELF.docx

PAST PERFORMANCE QUESTIONNAIRE: SELF CERTIFICATION

SECTION I: CONTRACT IDENTIFICATION

1. Contractor: ________________________________________________________________

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

3. Contract number: _______________________________________

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, other Commands, 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: __________________________________________________________________________

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 SOO/SOW/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. Cost Performance

a. Did the contractor effectively forecast, manage and control 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 costs?

Yes No If no, please explain: ____________________________________________________________________________________________________________________________________________________

For question number 6, please use ONE of the following performance levels to answer the question:

EXCEPTIONAL (E) – 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) – 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) – 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) – 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) – 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.

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

Exceptional Very Good Satisfactory Marginal Unsatisfactory

SECTION IV. RETURN OF COMPLETED FORM

Please return your completed form to:

Contract Specialist Name: Bradford Kelly Organization/Office Symbol: DoDEA Procurement Phone No.: (571) 372-1445 E-Mail Address:bradford.kelly@dodea.edu

Contracting Officer Name: Alim Koroma Organization/Office Symbol: DoDEA Procurement Phone No.: (571) 372-1473 E-Mail Address:alim.koroma@dodea.edu