Past Performance Questionnaire.docx

DOCX document 15 KB Posted

Attached to
AV and Simulation MATOC Federal contract opportunity
Solicitation number
HU0001-10-R-0001
Issued by
DOD Uniformed Services University of the Health Sciences

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Past Performance Survey

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Text version

Past Performance Survey

______(Insert Company Name)_______ is submitting a proposal in response to solicitation HU0001-10-R-0001 for audio visual (AV) and simulation support, to include services in the areas of design, installation, training and technical support and the furnishing of commercial AV and simulation equipment required by the Uniformed Services University of the Health Sciences (USU) located in Bethesda, Maryland. Your agency/business has been selected as a past performance reference. Please take a moment to complete this past performance questionnaire using the numeric ratings described below to answer each question, you may provide additional information. If you provide a rating other than 3 please explain why. Once you have completed the questionnaire please e-mail a copy to micreenan@usuhs.mil and a confirming copy to carolyn.lisovich.ctr@usuhs.mil. You may be contacted by USU for additional information regarding ______(Insert Company Name)_______ past performance history. If you have any questions please do not hesitate to contact Michelle Creenan at 301.295.3924 or micreenan@usuhs.mil. Thank you in advance for taking the time to complete this survey.

Agency/Business Name: ____________________________ Contract Number: ________________________________ Agency/Business POC: ____________________________ Telephone Number/E-mail Address: ________________________________ Your Role on in this Contract: ___________________________________

POC at ______(Insert Company Name)_____: (Name and Email-Completed by Offeror)

BRIEF DESCRIPTION OF SERVICES PROVIDED:

Rating
Definition
5
Vendor has greatly exceeded the Government’s expectation and has provided service in excess of the requirement.
4
Vendor has exceeded the Government’s expectation.
3
Vendor has met the Government’s expectation.
2
Vendor has met the Government’s expectation, with minimal problems.
1
Vendor has not met the Government’s expectation.
N/A
Neutral/Unknown Confidence

1. Contractor provides knowledgeable, experienced, trained and qualified personnel.

2. Contractor complies with contract requirements.

3. Contractor is responsive to technical direction.

4. Contractor met contract delivery schedules/deadlines.

5. Contractor provided sufficient notification of contract problems to appropriate government personnel.

6. Contractor is pro-active and is reasonable/cooperative.

7. Would you recommend this contractor for award (Yes or No)? Please explain.

8. Are you satisfied with the service you received and would you hire the contractor again (Yes or No)? If not, why not? Please be specific.

9. Do you feel the quality of the services received was worth the cost/price? Please circle one of the statements below.

A). Extremely well worth the cost.

B). Well worth the cost.

C). Worth the cost.

D). Cost was more than the value received.

E). Cost was greatly in excess of value received.

F). Government derived no value from cost spent.

File details come from the government source that posted it. Updated .