Past_Performance_Questionnaire.pdf

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Instructions to Offerors Sending Reference Questionnaire Forms:

Section A shall be completed by the Offeror (the firm requesting the reference) prior to issuing the questionnaires. The Offeror shall send the questionnaires for relevant projects completed in the past three (3) years of the proposal due date with twelve (12) months of the period of performance completed for the individuals who will provide the reference. For Government contracts, send to the Contracting Officer or Technical Representative. For commerical references, send to personnel with duties similar to those for Government contracts. It is the responsibiliy of the offeror to follow-up and encourage references to submit the questionnaire. The completed questionnaire shall be submitted via e-mail directly from the person providing the reference.

Instructions to Person Providing Reference:

In order to assess potential vendors under the Washington Headquarters Service / Acquisition Directorate (WHS/AD), Joint Service Provider (JSP) Audio-Visual/Video Conference (AV/VTC) Support Services, is obtaining past performance information with respect to each Offeror. As a reference for work performed by the firm identified in Section “A” of this questionnaire, your candid response will assist in the evaluation process. Please complete Section “B” of the questionnaire as thoroughly as possible.

The questionnaire must be submitted to whs.mc-alex.ad.mbx.ks@mail.mil by TBD. The subject line in the submission e-mail shall clearly indicate: JSP AV/VTC Support Services Past Performance Questionnaire Submission for <Company Name> and the message shall originate from the reference’s government or commercial e-mail system.

In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. This is a major WHS/AD acquisition and your input into this evaluation is greatly appreciated. If you have questions regarding this questionnaire or require assistance, please submit inquiries to whs.mc-alex.ad.mbx.ks@mail.mil.

Sincerely, Karen A. Smith Contracting Officer

SECTION B

TO BE COMPLETED BY EVALUATOR (PERSON PROVIDING REFERENCE)

PART I: REFERENCE INFORMATION NAME

& TITLE:

ORGANIZATION (INCLUDING AGENCYAND/OR COMPANY):

CONTRACT ROLE (e.g. CO, COR, PM):

ADDRESS:

PHONE NUMBER:

FAX NUMBER:

E-MAIL:

PART II: INFORMATION ABOUT PROJECT/CONTRACT FOR WHICH REFERENCE IS REQUESTED

Please identify and correct any information that is not accurate in Section A.

Please objectively assess the requesting firm in each performance element below by assigning an “X” to the most appropriaterating:

• Exceptional: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

• Very Good: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

• Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

• Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

• Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance Element Exceptional Very Good Satisfactory Marginal Unsatisfactory

1. QUALITY OF PRODUCT OR SERVICE

Assess the contractor’s performance to contract requirements, specifications, and standards of good workmanship (e.g. commonly accepted technical, professional, environmental, or safety and health standards).

Comments:

Signature/Date