Attachment III HSCG23-12-R-PBR006.pdf

Attachment III Past Performance Evaluation Document

RFP HSCG23-12-R-PBR006

CONTRACT DATA SHEET

SECTION A: TO BE COMPLETED BY CONTRACTOR

CONTRACTOR NAME____________________________________________________

(Complete one Contract Data Sheet per reference.)

Contract Number: Prime or Subcontractor:

Dollar Amount: Date Completed:

Contract Type: Fixed Price___ Cost Reimbursement ___ Other (Specify)

Item/Service Description:

Contract Quantity/Period of Performance:

Customer Activity:

Customer POC (Person who can verify data):

Address:

Phone:

FAX:

E-Mail:

SECTION B: TO BE COMPLETED BY GOVERNMENT

PERFORMANCE INFORMATION

YES NO

1 Were all supplies/services delivered within the original contract schedule?

2 Did all delivered supplies/services comply with the contract specifications/ statement of work?

3 Did any of the delivered supplies/services require replacement, modification or rework in order to be acceptable?

4 Were any modifications issued relaxing the contract specifications/delivery requirements?

5 Was any part of this contract terminated for default or cause?

6 Did you receive any quality awards in the past three years?

7 If applicable, describe any corrective action(s) initiated to solve any problems/deficiencies on this contract. Discuss the success of the corrective action(s) taken.

8 Overall Past Performance Rating (Check only one Box):

No rating (Neutral). The contractor has no relevant past performance.

Superior. One or more examples where past performance significantly exceeded requirements.

Satisfactory. Past performance met requirements (Color Code: Green).

Marginal. One or more examples where past performance failed to meet requirements due to fault of contractor. (Color Code: Yellow) Unsatisfactory. One or more examples where past performance significantly failed to meet requirements due to fault of contractor (Color Code: Red).