Attch 15 PPQ

Attachment 15 (Revision #1) HSCETC-11-R-00002

Contractor Performance Evaluation Survey

CONTRACTOR PERFORMANCE EVALUATION SURVEY

The Past Performance reference shall complete part III, sign and date part IV and return this survey directly to: Nancy J. Maples-Remley via facsimile: 202-732-7449 or via scanned emailed copy to nancy.maples-remley@dhs.gov" nancy.maples-remley@dhs.gov. Survey shall be returned not later than January 28, 2011, 3:00 pm (Eastern Standard Time) to the POC noted above. Your support I this matter is greatly appreciate.

I. CONTRACT IDENTIFICATION

A. CONTRACTOR _____________________________________________

B. CONTRACT NO. _____________________________________________

C. CONTRACT TYPE _____________________________________________

D. PERIOD OF PERFORMANCE _____________________________________

E. ACTUAL OR ESTIMATED

CONTRACT TOTAL _____________________________________________

(Including all possible option periods)

F. DESCRIPTION OF REQUIREMENT ________________________________

II. IDENTIFICATION OF PARTY PROVIDING INFORMATION

NAME OF ACTIVITY ___________________________________

(Include point of contact/phone #/ ___________________________________ fax #/address) ___________________________________

III. ASSESSMENT OF CONTRACTOR PERFORMANCE

Please rate the contractor’s performance in the following categories on a scale of 1 to 4 as follows:

1 = Marginal 2 = Satisfactory 3 = Good 4 = Outstanding

Also, please provide an explanation in support of each rating in the space provided.

C. BUSINESS RELATIONS: Please rate/explain the contractor’s management abilities relative to its use of personnel and subcontractors to meet the requirement, cooperation of personnel and subcontractors during performance, turnover of personnel and subcontractors, ability to solve performance problems.

1 2 3 4 (Circle one)

D. COMMITMENT TO CUSTOMER SATISFACTION: Please rate/explain the contractor’s communications with the Government staff, response to technical directions, maintenance and reporting of problems, effectiveness of contractor interface with Government staff. 1 2 3 4 (Circle one)

E. COST CONTROL: Please rate/explain the contractor’s cost control capabilities and accuracy of any projected cost changes. 1 2 3 4 (Circle one)

F. INNOVATION: Did this contract require the contractor to use innovative technical approaches? YES NO (Circle) Additional information or comments: _________________________________

G. PROGRAM MANAGEMENT: Please rate/discuss the overarching management as related to: Management of personnel, subcontractors, afterhours support and communications, meeting contract requirements, timely communication with all parties.

Additional information or comments: _________________________________

H. Would you recommend selection of this contractor again? YES NO (Circle) Additional information or comments: _________________________________

IV

Print name and title of person completing this form this reference (Government or Private Sector Contract POC)

Signature:________________________________________

Date:____________________________________________