Attachment_3_-_Past_Performance_Questionaire_8-6.doc

U.S. Department of Homeland Security

Washington, DC 20528

ATTACHMENT 3

PAST PERFORMANCE QUESTIONNAIRE

Solicitation: HSHQEC-15-R-00005

NAME OF CONTRACTOR REQUESTING THE REFERENCE: __________________

The purpose of this questionnaire is to obtain information regarding the quality of the above named Contractor’s past performance relative to a contract, completed or in progress, at your company/agency. The Federal Protective Service is considering this Contractor for leasing x-ray machines at numerous CONUS and OCONUS federal facilities. We would greatly appreciate your input regarding the quality of the Contractor’s past performance.

Handwritten responses are sufficient. It is requested that the individual(s) responsible for the administrative oversight of the project (e.g. security specialist, COR, COTR, etc.) respond to this questionnaire. More than one copy of the questionnaire may be submitted if responses from more than one individual are appropriate.

Upon completion of the survey, please email to josh.b.clemens@hq.dhs.gov . If you have any questions, please call Josh Clemens at (215) 521-2255. We appreciate your efforts on our behalf.

CONTRACT NO. OR PROJECT TITLE: _____________________________________

PERIOD OF PERFORMANCE TO

INCLUDE ALL OPTION PERIODS:_________________________________________

TOTAL PROJECT VALUE TO

INCLUDE ALL OPTION PERIODS: _________________________________________

ANNUAL NO. OF PROTECTIVE SECURITY OFFICER HOURS:_________________________________________ Please provide a brief description of the scope of this project so that we determine any similarities to this contract:

QUESTIONS

PERFORMANCE:

Please provide your comments on the Contractor’s performance in the following areas:

1. What is your overall assessment of the Contractor’s ability to meet the technical requirements?

Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What is your overall assessment of the Contractor’s ability to meet the schedule?

Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. How effectively does the Contractor respond to problems? Is the contractor proactive in identifying issues and resolving them on their own?

Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Discuss the Contractor’s overall management of the project Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Did this contract require the contractor to submit a subcontracting plan? If so, has the contractor been making a good faith effort to meet the subcontracting goals contained within the plan? (NOTE: The individual completing this questionnaire may need to contact the cognizant contracting officer in order to ascertain whether the contractor is meeting subcontracting goals.)

6. If you had a choice, would you hire this Contractor again? Why or why not?

7. In summary, would you describe the quality of the Contractor's services and overall performance as:

a. _____ Highly Acceptable – Based on the contractor’s performance under this project, the level of risk associated with this vendor is substantially less than the level expected from a competent vendor.

b. _____ Acceptable – Based on the contractor’s performance under this project, the level of risk associated with this vendor is no more than the level expected from a competent vendor.

c. _____ Unacceptable – Based on the contractor’s performance under this project, the level of risk associated with this vendor is greater than the level normally expected from a competent vendor.

Your Name:

Your Position:

Company:

Telephone No:

Fax:

E-mail address:

December 2013 Version