HSCG44-17-R-170052_DSL_Attachment_6_Past_Performance_Questionnaire.pdf

Attachment 6

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 Page 1

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)

Dollar Amount: Date Completed:

Contract Type: _____ Fixed Price _____ Cost Reimbursement _____ Other (Specify) (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:

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 Page 2

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

Rating Description

Substantial Confidence

Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.

Satisfactory Confidence

Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.

Neutral Confidence

No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned. The offeror may not be evaluated favorably or unfavorably on the factor of past performance.

Limited Confidence

Based on the offeror’s recent/relevant performance record, the Government has a low expectation that the offeror will successfully perform the required effort.

No Confidence Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 Page 3

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

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

TABLE 3 – PAST PERFORMANCE RATINGS

Category Rating

1. Confidence:

__Substantial Confidence __Satisfactory Confidence __Neutral Confidence __Limited Confidence __No Confidence

2. Relevancy __Relevant __Not Relevant

TABLE 2- RELEVANCY/ CURRENTENCY RATINGS

Rating Description

Relevant Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

Not Relevant Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires.

Current Contracts that are ongoing or completed within the past 3 years.

Not Current Contracts older than 3 years.

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 Page 4

3. Current _ Yes _ No

Additional Comments:

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...