PAST PERFORMANCE QUESTIONNAIRE.doc

PAST PERFORMANCE QUESTIONNAIRE

FOR SOLICITATION HE1260-09-R-6005/Musical Instruments and Related Supplies

(To be completed by the Offeror’s Client/Customer Reference)

The company listed below is being considered for a contract to be awarded by the Department of Defense Dependents Schools Pacific (DODDS-P) Procurement Division. We would appreciate it if you would provide us with comments regarding the company’s past performance. Your comments are considered Source Selection Sensitive and, therefore, your name as a reference will not be released. In order to maintain the integrity of the source selection process, we respectfully request that you do not divulge the name of the company, nor discuss your comments on this questionnaire, with any other business which may be interested in competing for the same contract.

PLEASE RETURN THIS FORM BY 1200 ON 04 June 2009 TO DODDS-P

VIA FAX TO: +81-98-957-4535, OR EMAIL TO: susan.phillips@pac.dodea.edu.

Please complete the applicable blocks below for each contract or project you have been requested to serve as a Client Reference for the Contractor.

Name of Company you are providing information on:

Circle how this company served in your project: as Prime Contractor or Subcontractor

Contract Number & Project Title, including location of worksite(s):

Evaluator: (The following information is needed in case we need to contact you for clarification or additional information. All information provided will be kept confidential).

Address:

City/State/Country:

Position held or function in relation to the Company’s project or contract:

Ratings: Please evaluate the Contractor’s performance using the following ratings:

Please rate and provide any supporting information for the following, but respond to only those that are applicable: (You may write remarks or comments next to the Rating. Use additional sheets as needed.)

1. The Contractor’s technical capability to perform project or contracted work:

Rating: ______

2. The Contractor’s on-site management and coordination of work requirements:

Rating: ______

3. The Contractor’s cooperative nature, integrity and reasonableness:

Rating: ______

4. The Contractor’s performance on urgent, emergency and/or contingency requirements (if any):

Rating: ______

5. The Contractor’s Quality Control (QC) system:

Rating: ______

6. The Contractor’s ability to meet performance schedules:

Rating: ______

7. The Contractor’s ability to simultaneously support multiple end users and customers from different locations:

Rating: ______

8. The Contractor’s quality of work:

Rating: ______

9. The Contractor’s compliance with document safeguarding and security procedures and requirements:

Rating: ______

10. The Contractor’s loss and damage prevention program as they relate to equipment or material you provided them for use on the contract or project:

Rating: ______

11. The Contractor’s ability to control costs:

Rating: ______

12. What type of performance problems did this Contractor have, if any, during your contract?

13. Do you think this Contractor would have any difficulty performing under adverse conditions? Please explain.

14. Would you award another contract to this Contractor or recommend him for a contract? If no, please state reason(s).

15. Were you, as the customer, satisfied with this Contractor’s overall performance?

16. Please provide any additional comments regarding this Contractor.

17. OVERALL RATING: Rating: ________