Attachment_5_-_Past_Performance_Questionnaire_-_DRAFT.docx

HTC711-19-R-R004

Attachment 5

SECTION 1: CONTRACT IDENTIFICATION

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

PAST PERFORMANCE QUESTIONNAIRE

Attachment 5

A. Contractor Name: _________________________________________________________________

B. Contract Number: _________________________________________________________________________

C. Contract type: __________________________________________

D. Period of performance: ______________________________________________________________

E. Brief Description of Work Performed: _______________________________________________________________________________

F. Dollar Value (include per year cost and life cycle cost) ______________________________________________

G. Annual Shipments (Volume in number or pounds) _________________________________________________

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

I. 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 by e-mail to: amy.m.miller50.civ@mail.mil, andrew.s.mcclain2.civ@mail.mil, paige.e.brown20.civ@mail.mil Due date: 5 August 2019 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 FOR OFFERORS

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 GHC 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. Regarding the element or sub-element being rated there should have been multiple significant events that were of benefit to your company (or agency). A singular benefit could be of such magnitude that it alone constitutes an Exceptional rating. There should have been no significant weaknesses identified.

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. Regarding the element or sub-element being rating, there should have a significant event that was of benefit to your company (or Agency). There should have been no significant weaknesses.

Satisfactory - Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. There should only be minor problems, or major problems that the contractor recovered without impact to the contract. There should have been no significant weaknesses identified.

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

Unsatisfactory - Performance did not meet most contractual requirements and recovery is not likely in a timely manner. There were serious problems and the contractor’s corrective actions appear or were ineffective.

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

NOTE 1: 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.

NOTE 2: Plus or minus signs may be used to indicate an improving (+) or worsening (-) trend insufficient to change the evaluation status.

Note 3: N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.

SECTION 4: NARRATIVE DESCRIPTION (Note: Answer length is not limited - text boxes below may be expanded as needed)

1. Please discuss each and every response for which you indicated Marginal or Unsatisfactory in response to the questions above.

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.

Thank you for your prompt response and assistance!