PAST PERFORMANCE QUESTIONNAIRE.doc

Contract # Being Evaluated ___________________ USC-7 HTC711-11-R-W004

SECTION 1: CONTRACT IDENTIFICATION

INSTRUCTIONS: This section is to be filled out by the contractor requesting information and sent to the respondent.

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

A. Contractor Name: _________________________________________________________________

B. Contract Number: _________________________________________________________________________

C. Contract type: __________________________________________ D. Period of performance: _________________________________________________

E. Initial Contract cost: $____________________________

F. Final Contract cost: $____________________________

G. Explain the reasons for differences between initial contract cost and final contract costs: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

H. Description (containerized) and Quantities (Annual or monthly) of requirements shipped under this contract: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I. Description (breakbulk) and Quantities (Annual or monthly) of requirements shipped under this contract: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

J. Number of voyages completed under this contract:

K. Location (countries) where service was performed under this contract:

L. Contractor being evaluated performed as the: _____ Prime or ______ Subcontractor (Mark one)

SECTION 2: RESPONDENT INFORMATION

INSTRUCTIONS: The remaining sections are to be filled out by Respondent. Once completed, respondent sends to USTRANSCOM Acquisition Office via E-mail to: USTCAQ-OTO-USC@ustranscom.mil. Please indicate “Performance Survey” in the subject.

A. Customer or agency name: ____________________________________________________

B. Respondent's name: __________________________________

C. Respondent's title: ____________________________________

D. Respondent's phone/fax number: ______________________________________

E. Respondent’s Email: ___________________________________

F. Contract Performance Data assessed in Contractor Performance Assessment Reporting System (CPARS): ________Yes or ________No

SECTION 3: PERFORMANCE INFORMATION

INSTRUCTIONS: Choose the term that most accurately describes the contractor’s performance or situation.

The results of this survey will aid the Government in determining whether there is a reasonable expectation that the contractor will successfully perform the required effort under the Universal Services contract (USC) 7 acquisition. In responding to the survey, please justify and explain Marginal, and Unsatisfactory ratings. Respondent may be contacted to clarify comments or ratings. In order for the government to review and assess the contractor’s past performance rating, please use the following ratings to describe the offeror’s performance on your contract or project:

Exceptional - Performance met all contract requirements and exceeded many to your company’s (or agency’s) benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

Very Good - Performance met all contract requirements and exceeded some to your company’s (agency’s) benefit. There were a few minor problems that the contractor resolved in a timely, effective manner.

Satisfactory - Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

Marginal - Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective or was not fully implemented.

Unsatisfactory - Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Unknown - No record of past performance or the record is inconclusive.

NOTE: If you have rated this contractor on this particular contract or project in CPARS or some other evaluation system accessible to the Government, you may indicate that past performance information on this contract/project is available in the appropriate system and you may include a copy of that rating in lieu of the following questionnaire.

SECTION 4: NARRATIVE DESCRIPTION

1. Please discuss each and every response for which you indicated Marginal, or Unsatisfactory in response to the questions above (use additional sheets, if necessary).

2. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? YES________ NO________

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

3. Explain the contractor’s greatest strengths and/or weaknesses and your rationale for why you would or would not award a future contract to them.

4. Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

5. Please provide any additional comments concerning this contractor’s performance, as desired.