Past Performance Questionnaire.doc

OSD/CAPE Analytical Support to Force Planning

HQ0034-11-R-0008

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and send by facsimile [FAX (703) 588-1990] to:

WHS Acquisition & Procurement Office

Attn: Marty Heule

1700 North Moore Street Suite 1425

Arlington, VA 22209

Desired Response Date:

3 Dec 2010

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

1b. NAME OF PRIME CONTRACTOR (If this questionnaire is for a team member)

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION ( Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

O = Outstanding

E = Excellent A = Adequate

M = Marginal P = Poor

N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, safety or health standards).

O E A M P N/O

B. Management – Assess the contractor’s management of the project.

A M P

C. Schedule – Assess the timeliness of contractor’s completion of various activities required by the contract.

A M P

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

A M P

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

A M P

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

A M P

G. Overall Assessment.

A M P

If an Award Fee contract, what was the average Award Fee %?