Amendment 2 - Attachment 5 - Past Performance Questionnaire.xls

XLS spreadsheet 35 KB Posted

Attached to
Post Award Information for D2T1 Awardees
Solicitation number
HSCG23-10-R-TABS00
Issued by

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Amendment 2 - Attachment 5 - Past Performance Questionnaire

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Sheet1

TABSS Solicitation, Amendment 2 - Attachment 5 - Past Performance Questionnaire
CONTRACTOR FILLS OUT THESE BLOCKS
REFERENCE FILLS OUT THESE BLOCKS
1. Name/Address of Contractor:
Company Name:
Division Name:
Street Address:
City, State, Zip Code:
Province/Country:
CAGE Code:
DUNS+4 Number:
FSC:
NAICS Code:
2. Period of Performance Being Assessed:
3. Contract Number:
4. Contracting Office:
5. Location of Contract Performance:
6a. Contracting Officer:
6b. Phone Number:
7a. Contract Award Date:
7b. Contract Effective Date:
8. Contract Completion Date:
9. Awarded Dollar Value:
10. Current Contract Dollar Value:
11. _ _Competitive ___Non-Competitive
12. Contract Type: ___FFP ___FPI ___FPR ___CPFF ___CPIF ___CPAF _ _ OTHER MIXED/OTHER:
13. Key Subcontractors and Effort Performed:
Subcontractor name and CAGE:
14. Program Title:
15. Contract Effort Description:
Small Business Utilization
Does this contract include a subcontracting plan?
Is small business subcontracting under this contract included in a comprehensive small business subcontracting plan?
Is small business subcontracting under this contract included in a commercial small business subcontracting plan?
Date of last Individual Subcontracting Report (ISR) / Summary Subcontracting Report (SSR):
16. Evaluate the Following Areas:Past RatingCurrent RatingTrend
Exceptional, Very Good, Satisfactory, Marginal or UnsatisfactoryExceptional, Very Good, Satisfactory, Marginal or UnsatisfactoryN/A, + or -
a. Quality of Product or Service
b. Schedule
c. Cost Control
d. Business Relations
e. Management of Key Personnel
f. Utilization of Small Business
g. Other Areas:
(1):
(2):
(3):
(4):
(5):
(6):
(7):
(8):
17. Assessing Official Narrative:
QUALITY OF PRODUCT OR SERVICE:
SCHEDULE:
COST CONTROL:
BUSINESS RELATIONS:
MANAGEMENT OF KEY PERSONNEL:
UTILIZATION OF SMALL BUSINESS:
OTHER AREAS:
(1)
(2)
(3)
(4)
RECOMMENDATION: Given what I know today about the Contractor's ability to execute what they promised in their proposal, I [FILL IN THE BLANK FROM THE CHOICES BELOW*] award to them today given that I had a choice.
* - Definitely Would Not, Probably Would Not, Might Not, Might, Probably Would, Definitely Would
Assessing Official Name
Assessing Official Title
Assessing Official Phone #
Assessing Official Email Address

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