HQ0013-18-R-0001_-_Att_D__-_PPQ_-_RFP_(1).docx

SAMPLE QUESTIONNAIRE COVER LETTER

LETTERHEAD

(Date)

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

The Defense Security Cooperation Agency (DSCA) is soliciting proposals for “Financial Improvement and Audit Readiness (FIAR), Audit Remediation, Financial Data Reconciliation, and Managers’ Internal Control Program (MICP)” services.

One of the considerations in proposal evaluations is the verification of the offerors' past and present performance on contracts, which reflect the offeror's ability to perform on the proposed effort. The Government depends on information received from Agencies such as yours, which have had firsthand experience with an offeror, for the evaluation of the offeror's performance on those contract(s).

The areas of interest for the Government are summarized in the questionnaire below. Questionnaires should be completed and returned to the offeror for submission with their proposal. Proposals are due _________ so we kindly ask for your response by ________ so it can be included in the proposal submission.

Please complete Sections II and III of the attached questionnaire of the attached questionnaire. Include your name and title, organizational address, e-mail address, telephone number. Use the rating scale and definitions found in the questionnaire to rate each performance element. Please sign the questionnaire.

The Government encourages comments. The last page may be used if additional space is needed for comments. Clear handwritten responses are sufficient.

Thank you for your time and participation.

Sincerely,

HQ0013-18-R-0001

ATTACHMENT D

PAST PERFORMANCE QUESTIONNAIRE

SECTION I: CONTRACT IDENTIFICATION (To be filled out by Offeror)

1. CONTRACTOR’S NAME & ADDRESS:

2. CAGE CODE OF PRIME CONTRACTOR:

3. CONTRACT NUMBER (include task number if applicable):

4. AWARD ENVIRONMENT:

|_| COMPETITIVE |_| NON-COMPETITIVE

5. CONTRACT TYPE:

|_| FIRM FIXED PRICE |_| COST + FEE

|_| FIXED PRICE + FEE |_| LABOR HOUR

|_| COST or COST SHARING |_| TIME & MATERIALS

|_| OTHER ___________________

6. PERIOD OF PERFORMANCE (including options):

7. INTIAL CONTRACT VALUE (including options):

8. CURRENT/FINAL CONTRACT VALUE (including options):

9. REASONS FOR DIFFERENCES BETWEEN INITIAL CONTRACT VALUE AND FINAL CONTRACT VALUE:

10. DESCRIPTION OF PRODUCTS/SERVICE PROVIDED:

11. LOCATION SERVICES PROVIDED (local, nationwide, worldwide, etc.):

SECTION II. EVALUATOR AND AGENCY IDENTIFICATION (To be filled out by the Evaluator)

1. AGENCY (CUSTOMER) NAME:

2. EVALUATOR NAME & TITLE:

3. EVALUATOR CONTACT INFORMATION:

TEL NO.:

E-MAIL:

4. NUMBER OF YEARS EVALUATOR WORKED ON SUBJECT CONTRACT:

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

Adjectival ratings definitions to be used in your response:

EXCEPTIONAL (E) (Blue): 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) (Purple): 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) (Green): 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) (Yellow): 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) (Red): 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.

No Knowledge of This Element (NA): No knowledge of this element or does not apply to meeting contractual requirements

SECTION III. PAST PERFORMANCE QUESTIONS/EVALUATION

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RATING

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OVERALL RATING

|_| EXCEPTIONAL

(E) (Blue)

|_| VERY GOOD

(VG) (Purple)

|_| SATISFACTORY

(S) (Green)

|_| MARGINAL

(M) (Yellow)

|_| UNSATISFACTORY

(U) (Red)

Comments:

EVALUATOR’S SIGNATURE Date