MSC Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Mobile Surveillance System

(Note: Complete questionnaire and email to MSC@dhs.gov)

I. Evaluation of Offeror:

Company/Division Providing Services: ___________________________________________

Address: ___________________________________________________________________

Description of Services Provided: _______________________________________________

Contract Number: _____________________ Dollar Value (Annual): ______________

Performance Period: ___________________ Performance Location: ______________

Type of Contract:

Check One:

Fixed Price ______ Cost Reimbursement ______ Other (Please Specify) _______

Check One:

Negotiated ______ Sealed Bid ______Competitive ______Non-Competitive _________

Basis of Payment:

Commodity ______ Labor/Equipment Hours ______ Other (specify) ______________

Type & Extent of Subcontracting: ________________________________________________

II. Evaluated by:

Company/Organization/Address: _________________________________________________

Name & Title: ________________________________________________________________

Signature: ______________________________________ Date: _______________________

Telephone: _________________________ FAX: ____________________________

III. Evaluation:

Please answer questions 1 through 15 using the following criteria. Circle only one response per question.

For elements rated "unsatisfactory", please comment on the specific problem(s) or performance failure(s) that prompted this rating.

4 - Exceptional: Performance met and exceeded many of the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with few minor problems for which corrective actions were highly effective.

3 - Very Good: Performance met and exceeded some to the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were effective.

2 - Satisfactory: Performance met contractual requirements. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were satisfactory.

1 – Marginal: Performance barely met contractual requirements. The contractual performance of the element being evaluated reflects a serious problem for which corrective actions have not yet been identified, appear only marginally effective or were not fully implemented.

0 – Unsatisfactory: Performance did not meet some contractual requirement and recovery is not likely in a timely manner. The contractual performance of the element being evaluated reflects serious problems for which corrective actions were ineffective.

N/A: Not Applicable or not observed.

1. Evaluate the contractor's overall commitment to quality performance and customer satisfaction.

4 3 2 1 0 N/A

Comment:

2. Evaluate the contractor's overall technical competence.

3. Evaluate the contractor's cooperation and willingness to work as a team (with your personnel, other contractors, etc.).

4. Evaluate the contractor's compliance with contractual requirements.

5. Evaluate the contractor's responsiveness to contract, program and/or schedule changes.

6. Evaluate the effectiveness of the contractor's overall quality control procedures.

7. Evaluate the effectiveness of the contractor's safety program or efforts.

8. Evaluate the effectiveness of the contractor's on-site management and supervision.

9. Evaluate the contractor's ability to overcome technical problems, labor issues, and/or other performance difficulties.

10. Evaluate the contractor's ability to plan and conduct operations in the most cost effective manner.

11. Evaluate the contractor's ability to adhere to schedules and complete work on time.

12. Evaluate the quality and stability of the contractor's workforce.

13. Evaluate the availability, adequacy and suitability of the contractor's staffing for the work required.

14. Evaluate the availability, adequacy and suitability of the contractor's gear and equipment for the work required.