Past Performance Questionnaire.doc

SOURCE SELECTION INFORMATION - SEE FAR 3.104

PAST PERFORMANCE QUESTIONNAIRE

The Washington Headquaters Services, Acquistion and Procurement Office (WHS/A&PO) is currently evaluating competitive offers for the services described herein. You have been named as a point of contact for the supplies and the services previously provided to you, by the contractor cited below. Please provide the information requested in the questionnaire. The information you provide will become a part of the source selection documentation, however your name will not be releasable to any of the parties. Should you have any questions concerning this request, please contact Ms. Meghan Morgan at meghan.morgan@whs.mil and 703.696.4013 Contractor:

Brief Summary of the Requirements/Statement of Work in the current Request for Proposal being evaluated: Provide printers and scanners on a per call basis to the Government. The total value to the Government will not exceed $3 Million dollars over the next five (5) years.

(To be completed by person to whom questionnaire is referred):

Background Information

a. Name of person completing this questionnaire and position with company.

________________________________________Phone: __________________

b. Contract Number: ____________________________________________

c. Description of service: ____________________________________

d. Period of Performance (all years): __________________________

e. Total value of the contract (all years)_____________________

Contractor's Past Performance

In your opinion, is the work performed under your contract similar in scope, magnitude and complexity as the work described above?

Please circle a rating in answer to each of the following questions and provide comments as appropriate.

1. To what extent did the contractor deliver quality services in a timely manner?

Outstanding Better Satisfactory Unsatisfactory

Comments:________________________________________________________

2. To what extent contractor's performance conform to the terms and conditions of the contract?

Outstanding Better Satisfactory Unsatisfactory

Comments:_______________________________________________________

3. To what extent was the contractor reasonable and cooperative during performance? (including cooperating with any successor contractor)

Outstanding Better Satisfactory Unsatisfactory

Comments: ______________________________________________________

4. To what extent was the contractor committed to customer satisfaction?

Outstanding Better Satisfactory Unsatisfactory

Comments: _______________________________________________________

In general, after considering all the above, how would you rate your overall customer satisfaction with the contractor:

(Please circle one)

Outstanding (Very highly satisfied)

Better (Above just being satisfied)

Satisfactory (Satisfied)

Unsatisfactory (Not satisfied)

Other comments: ______________________________________________________

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