PastPerformanceQuestionnaire_-_IWB.doc

ATTACHMENT 1

PAST PERFORMANCE QUESTIONNAIRE

NOTE: Offerors are responsible for requesting that their 3 references complete this past performance questionnaire. References shall return the completed questionnaire directly to the Domestic Dependent

Elementary and Secondary Schools (DDDESS) Procurement Office, Not Later Than (EST) 25 April 2014.

References shall not return the completed questionnaires to the requestors.

You have been identified as having been a customer of the following company for providing interactive display equipment, including receiving repairs and service requests on all equipment delivered by the company.

Requesting Company Name: ________________________________________________.

The Dept. of Defense Education Activity (DoDEA)/DDESS is conducting an evaluation of this company’s previous record of performance as part of a selection process to award a contract for similar services. We cordially request you complete and forward this questionnaire:

Not Later Than: __________, (EST) __________, __________ to the DDESSPROC@am.dodea.edu, attention ____________. For questions related to this form, please contact Mr. William Roberts,Contract Specialist, at (678) 364-8007.

1. Company Information

Name

Street Address

City State Zip Code

2. Point Of Contact (POC):

Name / Title

Phone Number Fax Number

Email Address

2. Services Received:

Briefly Describe Services Received: ___________________________________________________ Country Where Services Performed: ______________ Approx. Value of Services: $____________

Date You Began Using This Firm’s Services: ______________

6. Rate Services Received

Please rate products received by entering and “X” in the applicable rating block below :

Management effectiveness at identifying and correcting problems

Responsiveness to customer requirements, and commitment to customer satisfaction

Quality of workmanship

Experience, training and skill level of personnel accomplishing work

Overall satisfaction with service/performance

7. Please Provide Written Comments To Explain Your Ratings (Use Additional Sheets If Necessary):

8. Rated By:

Signature Printed Name & Title Date

Domestic Dependent Elementary and Secondary Schools (DDESS), Procurement Division

700 Westpark Drive, Peachtree City GA 30269-3554