Attachment_6_Past_Performance_Questionnaire.docx
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- Solicitation number
- ID08150033
- Issued by
-
GSA Federal Acquisition Service
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Attachment 6 Past Performance Questionnaire
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PAST PERFORMANCE QUESTIONNAIRE
Solicitation# Please complete this Questionnaire and e-mail to Contract Specialist, e-mail lisa.lefkowitz@gsa.gov
We are currently in the process of preparing our proposal for the General Services Administration, FAS, Solicitation Number ID08150033. As part of our proposal, we have listed you as a reference on our performance for this type of service with your agency under the previous/current contract listed below. Your input on our performance is therefore requested.
Please complete this Questionnaire and e-mail to Contract Specialist, e-mail lisa.lefkowitz@gsa.gov
Questionnaire is due to Lisa Lefkowitz no later than Jun 8, 2015 at 4:00 PM MST. Questionnaire must be submitted directly to the Contract Specialist on company letterhead if faxed or emailed from a corporate email account.
Thank you.
NAME OF OFFEROR:
Phone:
E-Mail:
I. Current or Historical Contract Information
CONTRACT REFERENCED:
1. Contract or Identifying Number: ________________________________________________
2. Contract type and value: _____________________________________________________________
3. Period of Performance: ______________________________________________________________________________
4. Brief description of services provided:
5. Which of the following correctly describe the contract work? (circle yes / no for each)
| Yes / No | (A) Multiple (at least 4) geographically dispersed (one of the facilities must be at least 1,000 miles from the other 3 facilities) facilities, |
| Yes / No | (B) Each of the facilities being at least 100,000 square feet, |
| Yes / No | (C) For maintenance and repair services, |
| Yes / No | (D) Of medical treatment facilities/complexes (defined as medical centers, hospitals, clinics, medical warehouse/support facilities, veterinary clinics, trauma center, research laboratories), and |
| Yes / No | (E) at least 4 of the following: (1) response to work order/service call type work; (2) the scheduling and dispatching of personnel type work; (3) scheduled and unscheduled maintenance and repair/alteration of various equipment items and systems found in a medical treatment facility type work; (4) personnel administrative responsibilities type work; and (5) urgent or emergency facility maintenance services type work. |
6. Name of Person Completing Questionnaire: _______________________________________
Agency/Company:
Title: __________________________________ Phone: _____________________________
E-mail: _____________________________________________________________________
II. EVALUATION. Please rate the Contractor in response to the questions below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.
Past Performance Evaluation
Question 1. Performance
What is your assessment of the Contractor’s performance of the contract requirements?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Performance
Comments, if any.
Question 2. Timeliness of Delivery of Goods and Services
What is your assessment of the Contractor’s delivery of goods and services in a timely manner?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Timeliness of Delivery of Goods and Services
Question 3. Quality of Delivery of Goods and Services
What is your assessment of the quality of the Contractor’s delivery of goods and services?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Quality of Delivery of Goods and Services
Question 4. Effective Management of Subcontractors
What is your assessment of the Contractor’s management of subcontractors?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Management of Subcontractors
Question 5. Cost Management
What is your rating of Contractor’s cost management performance on contract being assessed?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Cost Management
Question 6. Level of Communication Between Contracting Parties
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Level of Communication between contracting parties
Question 7. Proactive Management
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Management of Subcontractors
Question 8. What is your rating as customer of satisfaction with the Contractor’s performance?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
General Comments:
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