Attachment F Past Performance Questionnaire.doc

ATTACHMENT F

PAST PERFORMANCE QUESTIONNAIRE

INFORMATION TECHNOLOGY SECURITY SUPPORT SERVICES

HSTS03-11-R-CIO556

REQUESTED RESPONSE: NLT 10 January 2010 at 3:00 p.m. ET EVALUATOR: Please complete questionnaire then email to:

ITSSSinfo@dhs.gov OFFEROR: Complete sections I and II of this form for each company, contractor, subcontractor, entity, or team member for whom you are required to submit past performance information (see Section L). For each contract listed in the response to the RFP, provide one copy of the form to the Program Manager and one copy to the Contracts Administrator/Contracting Officer/Contract Specialist of the referenced firm, for completion.

EVALUATOR: Please cross-out and correct any information that is incorrect in Sections I and II, sign the evaluation after completing Section III, and then email the completed form as indicated in above box.

I. IDENTIFICATION OF CONTRACTOR BEING EVALUATED [Offeror – complete this section for each contract]:

1. Company/Division Providing Services:

2. Address:

3. Contract Number:

Dollar Value (Annual):

4. Performance Period:

Performance Location:

5. Type of Contract (Check One):

Fixed Price Cost Reimbursement Other (specify type)

6. Basis of Award (Check One):

Negotiated Sealed Bid Competitive Non-Competitive

7. Describe Type and Extent of Subcontracting:

II. EVALUATED BY [Offeror – complete this Section; Evaluator - please correct any misinformation and sign]:

Company/Organization Name:

Company/Organization Address:

Evaluator’s Name and Title:

Evaluator’s Signature:

Date:

Telephone:

Fax:

Email:

II. Evaluation [Evaluator - please complete this section]:

Please answer questions 1 through 15 using the following criteria. Circle only one response per question. For elements rated "unsatisfactory", please comment on the specific problem(s) or performance failure(s) that prompted this rating.

4 – Exceptional - Performance met and exceeded many of the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with few minor problems for which corrective actions were highly effective.

3 - Very Good - Performance met and exceeded some to the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were effective.

2 – Satisfactory - Performance met contractual requirements. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were satisfactory.

1 – Marginal - Performance barely met contractual requirements. The contractual performance of the element being evaluated reflects a serious problem for which corrective actions have not yet been identified, appear only marginally effective or were not fully implemented.

0 – Unsatisfactory - Performance did not meet some contractual requirement and recovery is not likely in a timely manner. The contractual performance of the element being evaluated reflects serious problems for which corrective actions were ineffective.

N/A - Not applicable or not observed.

1. Rate the contractor's overall commitment to quality performance and customer satisfaction.

4 3 2 1 0 N/A

Comment:

2. Rate the contractor's overall technical competence.

4 3 2 1 0 N/A

Comment:

3. Rate the contractor's cooperation and willingness to work as a team (with your personnel, other contractors, etc.).

4 3 2 1 0 N/A

Comment:

4. Rate the contractor's compliance with contractual requirements.

4 3 2 1 0 N/A

Comment:

5. Rate the contractor's responsiveness to contract, program and/or schedule changes.

4 3 2 1 0 N/A

Comment:

6. Rate the effectiveness of the contractor's overall quality control procedures.

4 3 2 1 0 N/A

Comment:

7. Rate the effectiveness of the contractor's on-site management and supervision.

4 3 2 1 0 N/A

Comment:

8. Rate the contractor's ability to overcome technical problems, labor issues, and/or other performance difficulties.

4 3 2 1 0 N/A

Comment:

9. Rate the contractor's ability to plan and conduct operations in the most cost effective manner.

4 3 2 1 0 N/A

Comment:

10. Rate the contractor's ability to adhere to schedules and complete work on time.

4 3 2 1 0 N/A

Comment:

11. Rate the quality and stability of the contractor's workforce.

4 3 2 1 0 N/A

Comment:

12. Rate the availability, adequacy, and suitability of the contractor's staffing for the work required.

4 3 2 1 0 N/A

Comment:

Thank you for your assistance in completing this Past Performance Questionnaire.

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