HQ0034-15-T-0088_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and email

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

TO BE COMPLETED BY OFFEROR

1. A. CONTRACTOR NAME & ADDRESS: 2. CONTRACT/SUBCONTRACT NO.:

3. CONTRACT/SUBCONTRACT INITIATION DATE:

4. COMPLETION DATE:

1.B. NAME OF PRIME OFFEROR, if this questionnaire is for a team member:

5. CONTRACT/SUBCONTRACT VALUE (with options):

6. TYPE OF CONTRACT (Fixed Price, GMP, FPI, etc.):

7. PROJECT TITLE, LOCATION, AND DESCRIPTION (INCLUDING TOTAL CONSTRUCTION VALUE):

Please add a continuation page if additional space is 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:

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

O = Outstanding E = Excellent

A = Acceptable M = Marginal

U = Unacceptable N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship.

O E A M U N/O

B. Schedule – Assess the timeliness of contractor against the schedule of activities.

C. Performance Requirements – Assess the contractor’s ability to fulfill the performance requirements of the contract.

D. Resource Management – Assess the contractor’s ability to provide and maintain personnel and other resources for the contract.

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

F. Overall Performance Assessment

10. If this was an award fee contract, what was the average award fee % earned?

Smithk Typewritten Text Karen A. Smith, karen.a.smith202.civ@mail.mil and janice.t.johnson5.civ@mail.mil Response Date: Before July 09, 2015

Smithk Typewritten Text