RFP_HSSS01-15-R-0058_-_Attachment_3_-_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

I. CONTRACT IDENTIFICATION

A. Contractor

B. Contract Number

C .Contract Type

D. Competitive? Yes _____ No_______

E. Follow-On (Incumbent)? Yes______ No_______

F. Period of Performance

G. Initial Contract Cost _____________________________

H. Current/Final Contract Cost _________________________

I. Service/Supply Provided:

II. AGENCY IDENTIFICATION (Customer)

A. Agency Name ______________________________________________________ B. Agency Description _________________________________________________

C. Geographic Distribution Of Services Under This Contract, i.e. Local, Nationwide, Worldwide

D. Number Of Locations/Customers Serviced By This

Contract_________________________

III. EVALUATOR IDENTIFICATION

A. Evaluator Name ___________________________________________________ B. Evaluator Title/Phone Number _______________________________________ C. Evaluator FAX Number_____________________________________________ D. Evaluator Signature __________________________ Date ________________

IV. EVALUATION

Please circle one response for each question.

A. CONTRACT EXECUTION HISTORY

1. Did the contractor provide for effective overall contract management/performance?

a. Considerably surpassed minimum requirements

b. Exceeded minimum requirements

c. Met minimum requirements

d. Less than minimum requirements

e. Considerably below minimum requirements

f. Not applicable to this contract

Comment:__________________________________________________________

2. Did the contractor adhere to established milestones/delivery times, taking into account all excusable delays?

c. Met minimum requirements

d. Less than minimum requirements

3. The contractor’s product/service met contract requirements consistently and reliably.

a. Agree completely

b. Agree significantly

c. Agree slightly

d. Disagree slightly

e. Disagree significantly

f. Disagree completely

4. Did the contractor submit required reports and documentation in a timely manner?

c. Met minimum requirements

d. Less than minimum requirements

e. Considerably below minimum requirements

f. Not applicable to this contract

5. Were the contractor’s reports and documentation accurate and complete?

b. Exceeded minimum contractual requirements

c. Met minimum requirements

d. Less than minimum

6. Did the contractor coordinate, integrate, and provide for effective subcontractor management?

c. Met minimum requirements

d. Less than minimum requirements

7. Was the contractor able to solve contract performance problems without extensive guidance from the government/customer?

a. Considerably successful

b. Generally successful

c. Marginal success

d. Little success

e. No success

8. Did the contractor’s quality control program provide an effective method for preventing deficiencies and correcting existing deficiencies?

a. Considerably successful

b. Generally successful

c. Marginal success

d. Little success

e. No success

B. TERMINATION HISTORY

9. Has this contract been partially or completely terminated for default or convenience?

Yes ____ Default ____ Convenience ____ No ____

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules)._______________________________________________________

10. Are there any pending terminations?

Yes ____ No ____ If yes, please explain and indicate the status.

V. NARRATIVE SUMMARY

What were the contractor’s greatest strengths in the performance of the contract?

What were the contractor’s greatest weaknesses in the performance of the contract?________________________________________________________________

The following section is provided for comments on areas that may not have been covered

Thank you for your time and assistance.

Please return this completed questionnaire to:

U.S. Secret Service

Procurement Division

Attn:

950 H St. NW

Washington, DC 20373-5802

(202) 406-XXXX, FAX (202) 406-6801

V. NARRATIVE SUMMARY