Past_Performance_Questionnaire.docx

ATTACHMENT B: 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 3:00 P.M, (EST) Friday, 1 May 2015. When emailing Questionnaires, the Solicitation Number (HEVAS6-15-T-0016) must be included in the subject line. 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 facility sustainment, maintenance and custodial services:

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 source selection process to award a contract for similar services. We cordially request you complete and forward this questionnaire:

Not Later Than: 3:00 PM (EST) Friday, 1 May 2015 to hillary.turnbull@am.dodea.edu or fax to 678-364-8076

For questions related to this form, please contact Hillary Turnbull, Contract Specialist, at (678) 364-8011.

1. Company Information Name Street Address City State Zip Code

2. Point Of Contact (POC):

Name / Title Phone Number Fax Number Email Address

5. Services Received:

Briefly Describe Services Received: ___________________________________________________ Country Where Services Performed: ______________ Approx. Value of Services: $____________ Performance period of most recent contract: ______________

6. Rate Services Received Please rate services 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

Work performed in time required by contract

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