HSBP1011Q0034_PAST PERFORMANCE QUESTIONNAIRE_01.19.11.doc

Department of Homeland Security

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

The company who has provided you with this form is proposing on a Department of Homeland Security, Bureau of Customs and Border Protection solicitation to provide janitorial services. Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important. Your response on this form shall be sent directly to Shaun G. Saad, the DHS Contracting Officer. Do not send back to the requesting company or individual. Please provide an honest assessment and return the questionnaire by fax or email to the address shown below: If you have questions, please contact Shaun G. Saad on (202) 344-1971. Facsimile: (202) 344-1093 – email: shaun.saad@dhs.gov.

PART TWO: GENERAL INFORMATION

1. OFFEROR’S NAME AND ADDRESS

2. CUSTOMER ORGANIZATION

3. CONTRACT NUMBER:

2a. EVALUATOR

4. CONTRACT VALUE :

NAME:

TITLE:

PHONE NO:

5. CONTRACT AWARD DATE:

6. CONTRACT COMPLETION DATE:

7. CONTRACT TYPE:

8. COMPLEXITY OF WORK (Circle

One Response):

DIFFICULT

ROUTINE

PART TWO: GENERAL INFORMATION CONTINUED

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

PART THREE: OFFEROR PERFORMANCE RATING

On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set of subfactors with four possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this offeror and indicate your assessment by placing an “X” under the appropriate heading. Offeror performance factors are:

A. QUALITY OF SERVICES/REPORTS

B. PROJECT MANAGEMENT - RESOURCE ALLOCATION

C. TIMELINESS OF PERFORMANCE

D. COST EFFECTIVENESS

Adjectival ratings are defined below and should be used as a reference in assessing performance:

OUTSTANDING =

Offeror’s performance significantly exceeded most or all contract requirements. Furthermore, the offer provided significant, unusual, unique, or worthwhile features or benefits and performance was of the highest quality. No risk anticipated with performance or customer satisfaction.

GOOD

Offer’s performance fully exceed many of the contract requirements.

Offeror’s performance has resulted in a high level of efficiency and productivity and quality. Very little risk anticipated with performance or lack of customer satisfaction.

ACCEPTABLE =

Offer’s performance met customer expectations or contract requirements. Some potential risk and lack of customer satisfaction anticipated based upon the offeror’s past performance.

MARGINAL

Offeror’s performance was less than satisfactory and could have stood improvement. Significant potential risk and degradation of performance anticipated based upon the offer’s past performance.

NEUTRAL

No relevant past performance available for evaluation. Proposal receives no merit or demerit for this factor.

(a) performance of services?

(b) delivery of goods?

(c) delivery of reports or other documentation?

PART THREE: OFFEROR PERFORMANCE RATING CONTINUED

1.

Has this contract been partially or completely terminated for default or convenience?

YES

Default

Convenience

NO

If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules - also include contract number, name, address, and phone number of Terminating Contracting Officer - TCO).

2.

What was the contractor’s greatest strength in the performance of the contract?

3.

What was the contractor’s greatest weakness in the performance of the contract?

4.

Would you award another contract to this contractor?

YES

No

COMMENTS:

PART FOUR: EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF EVALUATOR

TITLE OF EVALUATOR