Past Performance Questionnaire.doc

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a vendor evaluation for solicitation HQ0034-11-T-0027

Please complete this Questionnaire and email to:

Karen.smith@whs.mil WHS Acquisition Directorate

1777 N. Kent Street, Suite 12063 Arlington, VA 22209

Desired Response Date:

April 04, 2011

When complete, the information on this form is SOURCE SELECTION INFORMATION (FAR 2.101 & 3.104) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

1a: Name of Prime Contractor:

6. TYPE OF CONTRACT:

(FFP,CPFF, T&M, etc.)

7. BRIEF 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:

A. Quality of Products and Services – Please provide a statement regarding the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

B. Performance – Please provide a statement regarding the contractor’s performance for the project.

C. Cost/Schedule – Please provide a statement regarding the contractor’s ability to deliver services within cost and time lines specified.

D. Customer Satisfaction - Please provide a statement regarding the contractor’s responsiveness to customer needs and their ability to effectively communicate with Government personnel throughout the period of performance.

E. Area for Improvement – If you had to describe one area for improvement, what would it be? Please state the significance.