Past_Performance_Evaluation.pdf

PAST PERFORMANCE EVALUATION

U.S. Customs and Border Protection

Reference ___________________________________________

Prime Contractor: ___________________________________________ (Service Provider)

INSTRUCTIONS:

Prime Contractor (Participant) Reference

1. Fill-in Prime Contractor and Reference names at top of all pages

2. Complete Section A, “Information to be provided by Prime Contractor”

3. Provide all pages of completed form to

Reference.

1. Complete Section B “Questions to be answered by Reference

2. Fill out and sign Section B bottom

3. Return completed survey forms via email to mistelle.watkins@dhs.gov by 12:00PM EDT, June 13, 2017.

SECTION A

(INFORMATION TO BE PROVIDED BY PRIME CONTRACTOR)

Contract short name: ____________________________________________ Contract Number: ____________________________________________ Contractor Name: ____________________________________________ Check One: Prime Contractor ___ Sub-contractor ______

Short overview of the identified contract that supports the reference (include dollar value, length of contract and description of work performed):

Yes No Is contract currently active?

Has contract or any task been terminated or has the Contractor received a Cure Letter? (If yes, provide details on a separate page)

Is a termination pending for the contract or a task? (If yes, provide details on a separate page)

Name of reference completing form: _____________________________________

Agency/Command/Company: _____________________________________

Address: _____________________________________

Telephone #: _____________________________________

FAX #: _____________________________________

Relationship (Check One): COTR ___ Contracting Officer ____

PM ___

SECTION B - QUESTIONS TO BE ANSWERED BY REFERENCE

Please indicate a score on a scale of 1 to 5, with 5 being the highest (see rating guidelines, page 4), your satisfaction with the Contractor's performance in the area under question. If the question is "not applicable" please enter "N/A". The applicable rating guideline area is indicated in parentheses after each question.

# Question Score 1 How satisfied are you with the contractor’s ability to solve contract performance problems? (Quality of Product or Service)?

2 How successful was the contractor in establishing a pattern of teamwork with the Government? (Business Relations)

3 How successful was the contractor in conducting the necessary services? (Quality of Product or Service)

5 How successful was the contractor in preparing a quality report of their services? (Quality of Product or Service)

6 How would you rate the contractor’s deliverables in general?

(Quality of Product of Service)

7 How successful was the contractor in providing and retaining qualified personnel? (Business Relations)

8 How would you rate the contractor’s ability to meet project deadlines? (Timeliness of Performance)

9 How would you rate the contractor in providing project management and oversight? (Business Relations)

10 How likely would you be to hire this company again? (Likelihood of Hiring Company Again)

Signature of reference completing form: ______________________________

Printed name of reference completing form: ______________________________

Date reference completed form: ____________________________________

***Thank you for your time and assistance***

Rating Guidelines:

Rating: Please evaluate the contractor's performance using the following ratings only:

5 -"E" Exceptional The contractor's performance greatly exceeded the contract requirements.

4 -"HA" Highly

Acceptable The contractor's performance exceeded the contract requirements.

3- "A" Acceptable The contractor's performance met the contract requirements.

2 -"M" Marginal The contractor’s performance failed to meet the contract requirements (some material aspects of the contractor’s performance were less than satisfactory).

1- "U" Unacceptable The contractor’s performance failed significantly to meet the contract requirements (performance was poor).

"N/A" Not Applicable The item being rated does not apply or the evaluator has insufficient information to rate the item.