Attachment_3_-_PAST_PERFORMANCE_QUESTIONNAIRE.pdf

Attachment 3

PAST PERFORMANCE QUESTIONNAIRE

The offeror listed below has submitted a proposal in response to United States Secret Service Solicitation No. HSSS01-15-R-0031, entitled “Replacement of Target Systems and Maintenance/Repair”. Past performance is an important part of the evaluation criteria for this acquisition, so input from previous customers of the offeror is important.

This office would greatly appreciate you taking the time to complete this form. This information is to be provided to Danielle Donaldson and is NOT to be disclosed to the offeror either verbally or in writing. Please provide an honest assessment and return to USSS via email to Danielle.donaldson@usss.dhs.gov, no later than the due date of the proposals - March 31, 2015, 2:00 PM (Eastern). If you have any questions, please contact Danielle Donaldson at (202) 406-6812.

NAME OF OFFEROR: _____________________________________

ADDRESS: _____________________________________________

EMAIL ADDRESS: _____________________________________

Contractor Performance Form

1. Name of Contractor: ______________________________

2. Address: _________________________________________

3. Contract Number: _______________________________________

4. Contract Value (Base Plus Options): ________________________

5. Contract Award Date: ____________________________________

6. Contract Completion Date: ________________________________

7. Type of Contract: (Check all that apply) ( )FP ( )FPI ( )FP-EPA ( ) Award Fee ( ) CPFF-Completion ( ) CPFF-Term ( ) CPIF ( ) CPAF ( ) IO/IQ ( ) BOA ( ) Requirements ( ) Labor-Hour ( )T&M ( ) SBSA ( )8(a) ( )SBIR ( ) Sealed Bid( )Negotiated( )Competitive ( )Non-Competitive

8. Description of Requirement:

CONTRACTOR’S PERFORMANCE RATING

Ratings: Summarize contractor performance and circle in the column on the right the number which corresponds to the performance rating for each rating category. Please see reverse page for explanation of rating scale.

Quality of Product or Service

Comments

Cost Control

Comments 0

Timeliness of Performance

Comments 0

Business Relations

Comments

Customer Satisfaction - Is/was the Contractor committed to customer satisfaction? Yes No ;

Would you use this Contractor again? Yes No

Reason:

NAME OF EVALUATOR: ________________________________________

TITLE OF EVALUATOR: ________________________________________

SIGNATURE OF EVALUATOR:___________________________________

DATE:_____________________

MAILING ADDRESS:

PHONE #:__________________________________

Rating Guidelines: Summarize contractor performance in each of the rating areas. Assign each area a rating 0(Unsatisfactory), 1(Poor), 2(Fair), 3(Good), 4(Excellent) 5(Outstanding).

Use the following instructions as guidance in making these evaluations.

Quality Cost Control Timeliness of Performance

Business Relation

-Compliance with contract requirements -Accuracy of reports -Technical excellence

-Within budget(over/ under target costs) -Current, accurate, and complete billings -Relationship of negotiated costs to actual -Cost efficiencies -Change orders issue

-Met interim milestones -Reliable -Responsive to technical direction -Completed on time, including wrap-up and contract adm -No liquidated damages assessed

-Effective management -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems Reasonable/cooperati ve -Flexible -Pro-active -Effective small/small disadvantaged business sub-contracting program

0-Unsatisfactory Nonconformances are jeopardizing the achievement of contract requirements, despite use of Agency resources

Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources

Delays are jeopardizing the achievement of contract requirements, despite use of Agency’s resources

Response to inquiries, technical/service/admi nistrative issues is not effective

1-Poor Overall compliance requires major Agency resources to ensure achievement of contract requirements

Ability to manage cost issues requires major Agency resources to ensure achievement of contract requirements

Delays require major Agency resources to ensure achievement of contract requirements

Response to inquiries, technical/service/admi nistrative issues is marginally effective

2-Fair Overall compliance requires minor Agency resources to ensure achievement of contract requirements

Ability to manage cost issues requires minor Agency resources to ensure achievement of contract requirements

Delays require minor Agency resources to ensure achievement of contract requirements

Response to inquiries, technical/service/admi nistrative issues is somewhat

3-Good Overall compliance does not impact achievement of contract requirements

Management of cost issues does not impact achievement of contract requirements

Delays do not impact achievement of contract requirements

Response to inquiries, technical/service/admi nistrative issues is usually

4-Excellent There are no quality problems

There are no cost management issues

There are no delays

Response to inquiries, technical/service/admi nistrative issues is effective