ATTACH_6-_(A00004)_Past_Perf.Questionaire__HSBP1014R0058.docx
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- CTIMR Area 4 Modification A0005 Federal contract opportunity
- Solicitation number
- HSBP1014R0058
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Past Perf. Questionaire
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ATTACHMENT 5
Section L TAB C—PAST PERFORMANCE QUESTIONNAIRE
Agency/Owner Identification
Name (evaluator’s organization):
Respondents Name/Phone Number:
Contract Information
Contractor (company being evaluated):
Contract Number:
Contract Type[footnoteRef:1]: [1: Contract Types: FFP = Firm Fixed Price; CPIF = Cost Plus Incentive Fee; CPAF = Cost Plus Award Fee;
CPFF = Cost Plus Fixed Fee; T&M = Time and Materials ]
FFP
CPIF
CPAF
CPFF
T&M
Other
Competitive:
Yes
No
Follow-On:
Yes
No
Period Of Performance:
Initial Contract Value:
Current Contract Value:
Has this contract been partially or completely terminated for default or convenience?
No
Yes
Default
Convenience
If yes, please explain.
Brief Description of Product or Service Provided:
PAST PERFORMANCE QUESTIONAIRE (continued)
Please check the box next to the description, which best describes the Contractor’s performance on this contract. Use blank area below questions for any comments.
1. To what extent did the Contractor adhere to contract delivery schedules?
Always met schedule
Occasionally had delays of less than 30 days
Experienced one or more delay of greater than 30 days
Never met schedule
2. To what extent did the Contractor submit required reports and documentation in a timely manner?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
3. To what extent were the Contractor's reports and documentation accurate and complete?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
4. To what extent was the Contractor able to solve contract performance problems without extensive guidance from government counterparts?
Considerably successful
Generally successful
Little success
No success
5. Did the Contractor save/cost the Government/Owner money or provide other benefits as a result of innovative work applications?
Displayed considerable initiative
Displayed some initiative
Displayed little
Displayed no initiative
6. Did the Contractor commit adequate resources (people, materials, equipment, funding) in a timely fashion to meet contract requirement and successfully solve problems?
Provided abundant resources
Provided sufficient resources
Provided minimal resources
Provided insufficient resources
7.
To what extent did the Contractor submit required proposals and/or responses in a timely manner?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
8. To what extent did the Contractor’s products fulfill contract requirements and customer expectations?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
9. To what extent did the Contractor’s performance of services fulfill contract requirements and customer expectations?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
10. Was the Contractor cooperative and responsive to changing needs of the customer?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
11. To what extent was the Contractor's problem tracking/reporting documentation timely, accurate, and of appropriate content?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
12. To what extent was the Contractor effective in interfacing with the Government’s staff?
Extremely Effective
Generally effective
Generally ineffective
Extremely ineffective
13. Were any instances of required re-work due to lack of quality control by the Contractor?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
14. To what extent did the Contractor coordinate, integrate, and provide for effective subcontractor management?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
15. Were the required Small Business utilization goals met?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
16. To what extent did the Contractor demonstrate sensitivity to environmental compliance?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
17. To what extent did the Contractor meet repair/response times required by the contract?
Exceeded minimum requirements
Met minimum requirements
Less than minimum requirements
Not applicable
18. To what extent did the Contractor submit invoices in a timely and accurate manner?
Always
Most of the time
Some of the time
Seldom
19. To what extent did the invoices provide sufficient detail so that the Government/Owner could accurately evaluate the cost and performance progress?
Always
Most of the time
Some of the time
Seldom
20. To what extent did the Contractor deliver the product at the original agreed to price?
Always
Most of the time
Some of the time
Seldom
Are there any additional comments the Government should consider regarding this Contractor’s performance under your contract?
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