HSBP1014R0077_-_Past_Performance_Survey_Template_111014.doc

HSBP1014R0077

PAST PERFORMANCE INFORMATION SURVEY

Please complete the following questionnaire and return to the attention of daniel.stiller@dhs.gov by 06:00 PM EST, 12/04/2014.

This survey pertains to: ________________________________________________

Department/Component: _______________________________________________

Contract Number: _______________________ Date of Survey: ________________

Name of Person Completing Survey: _____________________________________

Signature of Person Completing Survey: __________________________________

Your Company/Agency: ________________________________________________

Your Role in this Contract (circle one):

Contracting Officer, Contract Specialist, Project Officer or Other ________________

Contract Value (including options): $______________________

Performance Period: ___________________________________

(including option periods)

Type of Contract: ______________________________________

Approximate percentage of work being performed (or completed) by subcontractor(s): ____________%

PAST PERFORMANCE INFORMATION SURVEY

Information on subcontractor(s) (where more than __________% of work was completed by the subcontractor):

Subcontractor

Program Manager

Phone

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Commentary to support rating shall be noted on page 4.

Assign each area a rating of 1 (Unsatisfactory), 1 (Satisfactory), or 3 (Excellent). Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle "N/A" (not applicable/no opinion).

QUALITY OF SERVICE__________________________________________________

1. Compliance with contract requirements

N/A

2. Accuracy of reports

N/A

3. Effectiveness of personnel

N/A

4. Technical Excellence

N/A

TIMELINESS OF PERFORMANCE_________________________________________

1. Met interim milestones

N/A

2. Reliability

N/A

3. Responsive to technical direction

N/A

4. Completed on time including wrap-up and contract administration

N/A

5. Met delivery schedules

N/A

BUSINESS RELATIONS_________________________________________________

1. Effective management, including management of subcontracts

N/A

2. Reasonable/cooperative behavior

N/A

3. Responsive to contract requirements

N/A

4. Notification of problems

N/A

5. Flexibility

N/A

6. Pro-active instead of reactive

N/A

CUSTOMER SATISFACTION____________________________________________

1.

The contractor is committed to customer satisfaction.

Yes No (circle one)

2.

Would you recommend selection of this firm again?

Yes No (circle one)

ADDITIONAL COMMENTS:

PAST PERFORMANCE INFORMATION SURVEY

RATING GUIDELINES

Contractor is not in compliance and is jeopardizing achievement of contract objectives

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