Attachment 4 - Questionnaire.pdf

PROCUREMENT SENSITIVE

ATTACHMENT 4 HQ0034-11-R-3071

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _____________________________________________________________

B. Cage Code: _______________________________________

C. Contract number: ___________________________________________________________________________

D. Was the referenced contractor the prime contractor on this contract? Yes____ No____

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _______________________________________________________________________

G. Place of performance: _______________________________________________________________________

H. Total contract price (inclusive of options): $______________________________________________________

I. Description of service provided: ______________________________________________________________

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

SECTION 3: REVIEWER IDENTIFICATION

A. Reviewer's name:

B. Reviewer's title:

C. Reviewer's phone/email address:

Number of months the reviewer worked on subject contract: _____________________

SECTION 4: EVALUATION

1. Please describe the effectiveness of the contractor's performance of providing uniforms within requested delivery times.

2. Please describe the average failure rate of providing the requested uniforms provided under the contract as well as circumstances that contributed to common uniform returns.

3. Please describe the effectiveness of the contractor’s responses to unexpected uniform returns.

4. Please describe the effectiveness of the contractor’s management of the contract (e.g. cost management, personnel management, level of customer intervention required).

5. Please describe your willingness to work with this company again in the future.

6. If a subcontracting plan was a requirement under this contract, please describe the extent to which the contractor adhered to the subcontracting plan during the performance of the contract .

Reviewer’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: ATTN: Charlene Thomas

WHS/AD

2521 S. Clark Road, Ste 3000

Arlington, VA 22202

Or Email a scanned copy to: Charlene.Thomas.Ctr@whs.mil