HSFEHQ-12-R-0017 Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION:

A. Contractor: ___________________________________________

B. Contractor Address: ____________________________________

C. Contract Number: ______________ Status: Active _____ Completed _____

D. Contract Amount: _____________

E. Period of Performance: __________________________________

F. Services Provided (Explain in detail the type of services provided by the contractor):

RESPONDENT IDENTIFICATION

A. Name:

B. Position and Title:

C. Phone Number:

D. Address:

E. Relationship and Time involved with Contractor:

F. Date questionnaire was completed:

CONTRACTOR RATING

1. In this section of the questionnaire you are asked to rate the contractor. Please indicate the rating that best applies. If you wish to elaborate on any of your answers, please provide comments at the end of this section. If more space is needed, continue your comments on a separate sheet of paper and attach it to this questionnaire prior to submitting it.

2. You are urged to supplement your own knowledge of the contractor’s performance with the judgement of others in your organization. Any marginal ratings should be supplemented with an explanatory narrative in the remarks block of this survey. If you circle a Yes/No type question No, please provide a corresponding explanation in the remarks block.

3. ONCE COMPLETED, THIS SURVEY WILL BE CONSIDERED SOURCE SELECTION SENSITIVE IN ACCORDANCE

WITH FAR PART 3.104

4. The following definitions are applicable rating levels for the contractor’s performance.

(E) Exceptional/High Confidence

Based on the offeror’s performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

(VG) Very Good/Significant Confidence

Based on the offeror’s performance record, little doubt exists that the offeror will successfully perform the required effort.

(S) Satisfactory/Confidence

Based on the offeror’s performance record, some doubt exists that the offeror will successfully perform the required effort.

(N) Neutral/Unknown Confidence

No performance record identifiable.

(M) Marginal/Little Confidence

Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve the contract requirements.

(U) Unsatisfactory/No Confidence

Based on the offeror’s performance record, extreme doubt exists that the offeror will successfully perform the required effort.

PAST PERFORMANCE QUESTIONS:

1. Are/Were you satisfied with the quality of services received?

Remarks:

E VG S N M U

2. Were there any times that you were dissatisfied? If so, please explain.

Remarks:

3. Did this offeror have the necessary experience in Explain any negative comments.

interpretation/translation services?

Remarks:

E VG S N M U

4. During the start-up period, did the offeror have the necessary manpower to perform in an efficient and timely manner?

Remarks:

E VG S N M U

5. Did the contractor provide adequate, competent and qualified personnel capable of meeting contract requirements throughout the performance period of the contract?

Remarks:

E VG S N M U

6. How effective was the contractor in meeting contractually agreed to price and controlling contingencies (i.e. changes, claims request for equitable adjustments, request for proposals, etc)?

Remarks:

E VG S N M U

1. Did the offeror demonstrate effective response to your needs in a timely and professional manner?

Remarks:

E VG S N M U

2. Did the offeror perform all phases of services, in your opinion, “Outstanding”, or “Unsatisfactory”?

Would you hire him/her again?

Remarks: