J-4 Past Performance Questionaire.doc

ATTACHMENT J-4

PAST PERFORMANCE QUESTIONNAIRE

Source Selection Sensitive

See FAR 2.101 and 3.104

TO:

FACSIMILE:

PHONE:

EMAIL:_________________________

Information Request

Washington Headquarters Services is currently in the process of soliciting offers for a contract for the provision of Pentagon Mechanical Systems Preventive Maintenance . [CONTRACTOR NAME] provided your name and organization as a reference regarding [CONTRACT DESCRIPTION past performance under [CONTRACT NO.]. Specifically, we are looking for past performance information in the following areas:

a.) Quality of Service b.) Timeliness or Scheduling of Service c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing (Including Subcontractors) In order for our team to compile its evaluation, we request that you complete the attached survey form and email it, and any other pertinent information by 3:00 pm on 5 Aug 2011 to Janice T. Johnson at janice.johnson@whs.mil Information can also be sent via facsimile to the attention of Janice T.Johnson at FAX: (703) 697-6045.

PAST PERFORMANCE QUESTIONNAIRE

SOURCE SELECTION SENSITIVE

See FAR 2.101 and 3.104

CONTRACTOR PERFORMANCE EVALUATION SURVEY

CONTRACTOR NAME:

CONTRACT NUMBER:

EVALUATION PERIOD:

CONTRACT VALUE: $

1.

Please describe the service/supply provided by the Contractor for your firm.

2.

Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Outstanding (A), Very Good (B), Satisfactory (C), Poor (D), or Unacceptable (F). See next page for definition of ratings. For all ratings EXCEPT “Satisfactory,” please provide a brief explanation.

OVERALL PAST PERFORMANCE RATING

Please provide an overall rating of the contractor’s past performance for the referenced contract/delivery order.

a.) Quality of Service:

Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence.

b.) Timeliness or Scheduling of Service/Deliveries:

Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction

Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business d.) Key Personnel and Staffing (Including Subcontractors)

Quality of key personnel and how well key personnel managed their portion of the contract.

3.

Would you hire this contractor to provide services for your organization in the future? _____ Please provide comments using additional pages, if desired.

Signed:__________________________________

Print Name: ______________________________

PAST PERFORMANCE DEFINITIONS

The following definitions are to be used when assessing past performance:

OUTSTANDING/VERY LOW PERFORMANCE RISK (A)

No doubt exists that the offeror will successfully perform the required effort.

VERY GOOD/LOW PERFORMANCE RISK (B)

Little doubt exists that the offeror will successfully perform the required effort.

SATISFACTORY/MODERATE PERFORMANCE RISK (C)

Some doubt exists that the offeror will successfully perform the required effort.

POOR/HIGH PERFORMANCE RISK (D)

Substantial doubt exists that the offeror will successfully perform the required effort.

UNACCEPTABLE/VERY HIGH PERFORMANCE RISK (F)

Extreme doubt exists that the offeror will successfully perform the required effort.

NEUTRAL (N)

The offeror, its subcontractors or team members and/or its key personnel have no significant performance record relevant or identifiable to the services to be performed.