Attachment_5-_Past_Performance_Questionnaire.pdf

Page 1 of 2 Version 1.0, Dated 5.13.2015

ATTACHMENT 5

PAST/PRESENT 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

(DDESS) Procurement Office, Not Later Than 2:00 p.m. (EST), 21 August 2015. When emailing Questionnaires, the

Solicitation Number (HEVAS6-15-T-0033) 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 Bus Transportation Services:

Requesting Company (Potential Offeror) Name: ___________________________________________________________

The Department 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 a similar requirement. We cordially request you complete and forward this questionnaire:

Not Later Than: 21 August 2015, 2:00 p.m. (EST) to alicia.prince@am.dodea.edu or fax to 770-632-8720

For questions related to this form, please contact Alicia Prince, Contract Specialist, at (678) 364-6854.

1. Company (Customer) Information

Name

Street Address

City State Zip Code

2. Point Of Contact (POC):

Name / Title

Phone Number Fax Number

Email Address

3. Products Received:

Briefly Describe Products/Services Received: _____________________________________________________________

Approx. Value of Products/Services Purchased: $______________

Date You Began Using This Firm: ______________

4. Rate Services Received

Please rate Contractor’s compliance to the contract by entering an “X” in the applicable rating block below :

O u ts ta n d in g

V er y G o o d

A cc ep ta b le

M ar g in al

U n ac ce p ta b le

N eu tr al

Quality of Products/Services – Products functioned for the intended use/Services provided in compliance with contract requirements

(Performance Work Statement, Quality Assurance Surveillance Plan, etc.).

Responsiveness to customer requirements to include installation, customer complaints and commitment to customer satisfaction.

Overall satisfaction with Products/Services.

mailto:alicia.prince@am.dodea.edu

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

6. Rated By:

Signature Printed Name & Title Date

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

700 Westpark Drive, Peachtree City GA 30269-3554