Attachment_7-_SINS-2_Past_Performance_Questionaire.docx

Attachment A

Past Performance Questionnaire (Complete one form per reference)

Please fill out the following information in regards to the solicitation.

SECTION A – TO BE COMPLETED BY OFFEROR

Offeror:

Contract Number:

BPA Number:

Order Number:

_____ Prime or _____ Subcontractor (Check one)

(Check one)

Item/Service Description:

Contract Quantity/Period of Performance:

Customer/Business/Agency Name:

Customer POC (Note: Ensure POC information is valid and current) Name:

Address:

Phone:

E-mail:

SECTION B – TO BE ADMINISTERED BY THE GOVERNMENT

The offeror in Section A provided you as reference for a solicitation they are a party to. Please complete the following.

Evaluation Indicate the contractor’s past performance for each category area and overall by identifying with an “x” of check mark for the most appropriate rating according to the scale shown below. Provide rationale, including specific examples, as appropriate, to support your ratings in the space provided for comments for each category area. If more space is needed, continue your comments in the “Additional Comments” section at the end of this questionnaire.

Use the rating definitions in Table 1 to perform contractor confidence assessments where appropriate.

TABLE 1 – CONFIDENCE ASSESSMENT RATINGS

Use the rating definitions in Table 2 to perform contractor relevancy assessments where appropriate.

TABLE 1- RELEVANCY RATINGS

Use the Table 3 to assess contractor past performance where appropriate.

TABLE 3 – PAST PERFORMANCE RATINGS

1. Confidence:

__Substantial Confidence __Satisfactory Confidence __Neutral Confidence __Limited Confidence __No Confidence

__Not Relevant

Additional Comments: