ATTACHMENT_5_Past_Performance_Questionnaire.docx

ATTACHMENT 5 Past Performance Questionnaire

RFQ HSTS01-17-Q-CKP064-REV – ATTACHMENT 5 PAST PERFORMANCE QUESTIONNAIRE

PART A: TO BE COMPLETED BY THE QUOTER

Instructions: Quoters shall fully complete the information requested below and submit this attachment to the Government in their Volume II: Past Performance response in accordance with the submission instructions prescribed in RFQ Section V “Instructions for Submitting Quotations” (RFQ Pages 36 – 39). Quoters may either type or legibly write their information in the form below.

Name of Quoter:

Name of Past Performance Reference (Government Agency or Private Organization):

Description of work performed:

Contract Period of Performance:

Total dollar value of contract:

Name of Point of Contact at the Past Performance Reference:

Phone Number:

Email Address:

RFQ HSTS01-17-Q-CKP064-REV – ATTACHMENT 5 PAST PERFORMANCE QUESTIONNAIRE

PART B: TO BE COMPLETED BY THE PAST PERFORMANCE REFERENCE

Instructions: Please complete the following past performance questionnaire and return it to Mr. Michael Capovilla at michael.capovilla@tsa.dhs.gov in a Microsoft Word or Adobe PDF compatible document no later than: 3:00 PM local Washington D.C. time on Friday, September 1, 2017. Responses may either be typed or legibly written in the form below.

This Questionnaire pertains to:

Name of person completing this questionnaire:

Your agency/company name:

Your role in the contract:

General description of products/services required under the contract:

PAST PERFORMANCE RATINGS

Instructions: Please rate each of the following statements with a rating that is based on an objective appraisal of the vendor’s performance. Assign each a rating of either “Satisfactory” or “Unsatisfactory”. Annotate with N/A if the statement does not to apply your contract. For any rating of “Unsatisfactory”, please provide an explanation in the comments field below.

Additional Comments: