PAST PERFORMANCE QUESTIONAIRRE.pdf

Source Selection Sensitive Information For Official Use Only

PAST PERFORMANCE QUESTIONAIRRE

All Questionnaires are due by ___________________________ Absolutely no late questionnaires will be accepted, no exceptions.

SOLICITATION #: _______________________________________________________________________

TO: Government agency or commercial organization (i.e., customer) with knowledge on offeror’s past performance.

Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the Federal Emergency Management Agency (FEMA). Handwritten responses are acceptable; however, typed responses are preferred. The contractor who provided FEMA with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of a the questionnaire, they are authorizing you to release information to FEMA relative to their past performance, whether it is positive or negative information.

Please fill out the attached questionnaire and return it to the Offeror in an envelope both taped and signed across the seal. FEMA may contact you to clarify or verify any information provided.

Source Selection Information - See FAR 3.104

CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Block 1. Contractor

Block 2. Contract Name/Identifier

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE

AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Evaluator’s Printed Name

Title/Role (e.g. Program Manager, Contracting Officer)

Evaluator’s Mailing Address (Agency, Bldg/Rm, Street, City, State, Zip)

Evaluator’s Signature Date Phone Fax

INSTRUCTIONS

Two forms are provided to document your opinion: 1) Performance Rating Form; and 2) Supplemental Comment Form. Please fill out each form in accordance with the instructions provided on each. Please use the following standards in arriving at your rating:

Outstanding - The Evaluation Factor response is expected to contribute to the superior achievement of the objectives with minimal or no risk. An OUTSTANDING rating indicates that the submission contains very significant strengths and no weaknesses. Performance meets contractual requirements and exceeds many requirements. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Good - The Evaluation Factor response is expected to introduce minimal risk in achieving the objectives.

A GOOD rating indicates that the submission contains considerable strengths and few weaknesses.

Performance meets contractual requirements and exceeds some requirements. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable - Contractor, on balance, met customer expectations and requirements. The Evaluation Factor response is expected to introduce some risk in achieving the objectives. An ACCEPTABLE rating indicates that strengths offset weaknesses. Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which correction actions taken by the contractor appear or were satisfactory.

Unacceptable - Contractor, on balance, was either marginal or did not meet customer expectations and requirements. The Evaluation Factor response is expected to introduce excessive risk making it highly unlikely that performance would meet the objectives. An UNACCEPTABLE rating indicates that the submission contains significant weaknesses and few, if any, strengths. Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Neutral - The element is not applicable, no data has been obtained, or additional comments are provided. No relevant past performance available for evaluation. Unable to provide a score. Performance in this area not applicable to effort assessed.

Please mark the column to the right of each element that most appropriately reflects your experience with this contractor. Please use the additional page to discuss more fully any of the elements. Whenever you mark “Other”, please provide comments.

Performance Element Outstanding Good Acceptable Unacceptable Neutral

1. QUALITY OF SOLUTION: The contractor comprehended the goals, thoroughly researched the problem, and presented a comprehensive, complete, feasible, and effective solution. (Met the needs and performed successfully).

2. EFFECTIVE AND EFFICIENT USE OF RESOURCES: The Contractor deployed, in a timely manner, the proper amount and type of personnel, facilities, and other resources to support the project. Use of subcontractors was appropriate in supporting the project.

3. COMMUNICATION: The contractor worked and communicated well with client management, staff, and contracting officials as well as with his or her own staff and subcontractors.

4. TIMELINESS OF PERFORMANCE: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time.

5. CUSTOMER SATISFACTION: The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.

6. RESPONSIVENESS AND ATTENTIVENESS: The contractor exhibited reasonable and cooperative behavior in response to client changes, criticism/rejection of contract deliverables and in detecting and correcting errors, poor performance, and other problems.

7. COST CONTROL: The contractor successfully planned and proposed realistic costs and monitored performance, and consistently operated at or below budget.

For #8 and #9 please answer "Yes" or "No" as appropriate YES NO

8. Given the choice would you do business with this contractor again?

9. Did either you or the contractor have to resort to litigation to resolve problems?

Supplemental Comment Form

Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. Please add additional pages as necessary.

Performance Element #1, Quality of Solution:

Performance Element #2, Effective and Efficient Use of Resources:

Performance Element #3, Communication:

Performance Element #4, Timeliness of Performance:

Performance Element #5, Customer Satisfaction:

Performance Element #6, Responsiveness and Attentiveness:

Performance Element #7, Cost Control:

Question #8, Given the choice would you do business with this contractor again?:

Question #9, Did either you or the contractor have to resort to litigation to resolve problems?:

Additional Comment

Source Selection Sensitive Information For Official Use Only