Attachment 3 - PAST PERFORMANCE QUESTIONAIRE.doc

HSHQEH-11-R-00007

Attachment 3

PAST PERFORMANCE INFORMATION

CONTRACTOR PERFORMANCE CUSTOMER SURVEY QUESTIONNAIRE

Please complete the following questionnaire and return it to the attention of the individual named below, no later than September 22, 2011.

Peter J. Andrews Contracting Officer 701 Market Street, Suite 4200

Philadelphia, PA 19106

Telephone Number (215) 521-2261 Email address: peter.andrews@dhs.gov

This survey pertains to: __________________________________________________________ Department/Component: _________________________________________________________

Solicitation Number: ____________________________________________________________

Date of Survey: ________________________________________________________________

Name of Person Completing Survey: _______________________________________________

Signature of Person Completing Survey: _____________________________________________

Your Company/Agency:________________________________________________________

Your Role in this Contract: _______________________________________________________

Survey Period of Performance: ____________________________________________________

Name of Instructor:

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Assign each area a rating of either 4 (Outstanding), 3 (Good), 2 (Acceptable), or 1 (Unsatisfactory). Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. Annotate with N/A if not a rating consideration or inapplicable to the contract effort.

QUALITY OF SERVICE:

1. Compliance with contract requirements:

N/A

2. Accuracy of information provided:

N/A

3. Level of knowledge, experience, and training of personnel:

N/A

4. Capability of personnel to perform required services:

N/A

5. Effectiveness of personnel in performing required services:

N/A

6. Overall quality of service:

N/A

TIMELINESS OF PERFORMANCE:

1. Reliability:

N/A

2. Responsive to technical direction:

N/A

3. Meets contract delivery schedules and/or task deadlines:

N/A

BUSINESS RELATIONS:

1. Effective management, including subcontracts:

N/A

2. Reasonable/cooperative behavior:

N/A

3. Responsive to contract requirements:

N/A

4. Notification of problems:

N/A

5. Flexibility:

N/A

6. Pro-active vs. reactive:

N/A

COST CONTROL:

1. Current, accurate and complete billings:

N/A

2.

Relationship of negotiated costs to actuals:

N/A

3. Cost efficiencies:

N/A

CUSTOMER SATISFACTION:

1.

The contractor is committed to customer satisfaction:

a. Contractor Management Personnel

(circle one) Yes No

b. Contractor Onsite Facility Personnel

(circle one) Yes No

ADDITIONAL COMMENTS:

Enclosure 2