Past_Performance_Survey.doc

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?

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:__________________________________________________________

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

Comment:__________________________________________________________

4.

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

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:__________________________________________________________

5.

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

a.

Considerably surpassed minimum requirements b.

Exceeded minimum contractual requirements c.

Met minimum requirements d.

Less than minimum e.

Considerably below minimum requirements f.

Not applicable to this contract

Comment:__________________________________________________________

6.

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

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:__________________________________________________________

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 f.

Not applicable to this contract

Comment:__________________________________________________________

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 f.

Not applicable to this contract

Comment:__________________________________________________________

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.

HSSS01-17-R-0036

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