Attachment_III_-_Past_Performance_Questionnaire.xls
XLS spreadsheet 49 KB Posted
- Attached to
- TSA Recruitment and Hiring Services
- Solicitation number
- HSTS01-16-R-HRM037
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Attachment III - Past Performance Questionnaire
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Sheet1
| Solicitation - HSTS01-16-R-HRM037 | |
| Past Performance Questionnaire | |
| OFFEROR FILLS OUT THESE BLOCKS (GREEN) | |
| OFFEROR'S REFERENCE FILLS OUT THESE BLOCKS (YELLOW), THEN EMAILS THIS FORM DIRECTLY TO: PFPAcqTeam@tsa.dhs.gov | |
| 1. Name/Address of Contractor: | |
| Company Name: | |
| Division Name: | |
| Street Address: | |
| City, State, Zip Code: | |
| NAICS Code: | |
| 2. Period of Performance Being Assessed (contracts ongoing or completed within last three years): | |
| 3. Contract Number: | |
| 4. Contracting Office: | |
| 5. Location of Contract Performance: | |
| 6a. Contracting Officer: | |
| 6b. Phone Number: | |
| 7a. Contract Award Date: | |
| 7b. Contract Effective Date: | |
| 8. Contract Completion Date: | |
| 9. Awarded Dollar Value: | |
| 10. Current Contract Dollar Value: | |
| 11. _ _Competitive ___Non-Competitive | |
| 12. Contract Type: ___FFP ___FPI ___FPR ___CPFF ___CPIF ___CPAF _ _ OTHER MIXED/OTHER: | |
| 13. Key Subcontractors and Effort Performed: | |
| Subcontractor name and CAGE: | |
| 14. Program Title and Phase of Acquisition: | |
| 15. Contract Effort Description: | |
| Small Business Utilization | |
| Does this contract include a subcontracting plan? | |
| Is small business subcontracting under this contract included in a comprehensive small business subcontracting plan? | |
| Is small business subcontracting under this contract included in a commercial small business subcontracting plan? | |
| Date of last Individual Subcontracting Report (ISR) / Summary Subcontracting Report (SSR): | |
| 16. Evaluate the following Areas: | Rating |
| 5: Exceptional |
4: Very Good 3: Satisfactory 2: Marginal 1: Unsatisfactory
| N/A: Not Applicable, Observed, or Performed | 1-5 or N/A |
| a. Quality of Service | |
| b. Schedule Control | |
| c. Cost Control | |
| d. Federal Information Security Controls (i.e., successfully completing a Federal Security Authorization process leading to an Authorization to Operate (ATO), as governed by the Federal Information Security Management Act (FISMA)) and/or related Federal requirements. | |
| e. Management of Key Personnel | |
| f. Utilization of Small Business | |
| g. Adapting to Change | |
| h. Transition-in / Transition-out (i.e., the efficiency and effectiveness of beginning and ending a contractual engagement, and level of cooperation with the government and/or other service providers). | |
| 17. Assessing Official Narrative: | |
| QUALITY OF SERVICE: | |
| SCHEDULE CONTROL: | |
| COST CONTROL: | |
| FEDERAL INFORMATION SECURITY: | |
| MANAGEMENT OF KEY PERSONNEL: | |
| UTILIZATION OF SMALL BUSINESS: | |
| ADAPTING TO CHANGE: | |
| TRANSITION-IN AND/OR TRANSITION-OUT | |
| RECOMMENDATION: Given what I know today about the Contractor's ability to execute what they promised in their proposal, I [FILL IN THE BLANK FROM THE CHOICES BELOW*] award to them today given that I had a choice |
*Definitely Would Not, Probably Would Not, Might or Might Not, Probably Would, Probably Would Not
| Other Areas: |
| (1) |
| (2) |
| (3) |
| (4) |
| Assessing Official Name |
| Assessing Official Title |
| Assessing Official Phone # |
| Assessing Official Email Address |
File details come from the government source that posted it. Updated .