Attachment_11_Past_Performance_Survey_Questionnaire_Amd03.docx

General Services Administration (GSA)/Assisted Acquisition Services (AAS) Office of Professional Services and Human Capital Categories (PSHC)

ATTACHMENT 11

PAST PERFORMANCE SURVEY QUESTIONNAIRE

Request for Proposals EPA Custodial Services

ID10180005

Your immediate attention is requested. Please email the completed past performance reference survey questionnaire form ONLY to the following GSA, AAS, PSHC Contracting Officer: Maria.Colville@GSA.Gov. The completed questionnaire must be received by the identified Contracting Officer no later than 12:00 PM PDT on May 1, 2018.

NOTE: DO NOT PROVIDE A COPY OF THIS COMPLETED FORM TO THE OFFEROR FOR WHICH YOU ARE COMPLETING THIS SURVEY FOR. LATE SUBMISSIONS MAY NOT BE CONSIDERED BY THE GOVERNMENT.

You have been identified as a reference for__________________ (insert name of offeror company for which you are completing this past performance survey questionnaire for). Using the rating table, please provide concise comments and ratings (circle, underline, or highlight as appropriate) regarding your average overall assessment of the offeror’s performance under the identified contract, considering up to the past 3 years (if applicable), on the contract identified below. The Government may contact the reference name given to clarify the work your company provided (or is providing) on the contract/task order to assist in determining rationale for rating and/or relevancy for evaluation purposes.

CONTRACT DESCRIPTION INFORMATION:

(NOTE: THE FOLLOWING CONTRACT DESCRIPTION INFORMATION SHALL BE FILLED OUT BY THE REQUESTING PRIME OFFEROR AND PROPOSED SUBCONTRACTOR, IF APPLICABLE, FOR EACH PROJECT BEING SUBMITTED FOR PAST PERFORMANCE REFERENCE PURPOSES.)

1. Contract Number:

2. Customer Organization Name or Customer Contractor Name

3. Contract Type (e.g., FFP, T&M):

4. Total Award Amount for all Periods:

5. Period of Performance Dates, including any Options, of Contract:

6. Type and Number of Security Clearances Required: (CO: Only include if your acquisition involves the need for Security Clearances)

7. Brief Description of services:

RATING DEFINITION TABLE FOR SURVEY

TO BE COMPLETED BY CUSTOMER REFERENCE

QUALITY OF SERVICES

1. PLEASE COMMENT AND RATE THE QUALITY OF PRODUCTS OR SERVICES PROVIDED BY THE CONTRACTOR.

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

SCHEDULE

2. PLEASE COMMENT AND RATE THE TIMELINESS OF DELIVERABLES AND SERVICES PROVIDED BY THE CONTRACTOR AND ADHERENCE TO THE PROPOSED PROJECT SCHEDULE.

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

COST CONTROL (DO NOT RATE IF THE CONTRACT OR TASK ORDER WAS FIRM-FIXED-PRICE, UNLESS UPWARD REVISIONS TO THE FFP WERE NECESSARY DURING PERFORMANCE)

3. PLEASE COMMENT AND RATE HOW WELL THE CONTRACTOR PROVIDED SERVICES WITHIN THEIR INITIALLY PROPOSED AWARDED PRICE/COST.

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

MANAGEMENT

4. PLEASE COMMENT AND RATE HOW WELL THE CONTRACTOR WAS COOPERATIVE AND RESPONSIVE TO CHANGING TECHNICAL AND/OR FUNCTIONAL NEEDS OF THE CUSTOMER; AND HOW WELL THE CONTRACTOR MANAGED ITS OWN PERSONNEL, AND MANAGED THE USE OF ANY SUBCONTRACTORS (BOTH LARGE AND SMALL).

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

UTILIZATION OF SMALL BUSINESS (ONLY APPLICABLE TO PRIME OFFEROR)

5. DID THE PRIME CONTRACTOR SUBCONTRACT ANY PART OF YOUR EFFORT TO A SMALL BUSINESS? IF APPLICABLE, PLEASE COMMENT AND RATE THE EXTENT OF SMALL BUSINESS UTILIZATION.

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

REGULATORY COMPLIANCE

6. PLEASE COMMENT AND RATE HOW WELL THE CONTRACTOR UNDERSTOOD AND COMPLIED WITH ANY REQUIRED AND/OR UNIQUE REGULATIONS SPECIFIC TO YOUR REQUIREMENT.

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

OTHER AREAS (PLEASE STATE APPLICABLE TOPICS)

7. IF THERE ARE ANY OTHER AREAS NOT OTHERWISE COVERED BY THE TOPICS ABOVE THAT YOU FEEL WOULD BE PERTINENT TO THE GOVERNMENT’S PAST PERFORMANCE EVALUATION OF THIS OFFEOR, PLEASE PROVIDE AS DEEMED APPLICABLE.

Topic(s):

Strengths:

Weaknesses:

Rating: □ EXCEPTIONAL □ VERY GOOD □ SATISFACTORY □ MARGINAL □ UNSATISFACTORY

PERFORMANCE TRENDS OVER THE LAST 3 YEARS

8. DURING AND/OR UPTO THE LAST 3 YEARS OF THE IDENTIFIED CONTRACT, HOW HAS THE GENERAL QUALITY OF PERFORMANCE TRENDED:

Rating: □ UPWARDS □ ABOUT THE SAME □ DOWNWARDS

Comments:

YOUR COOPERATION IN COMPLETING THIS SURVEY IS GREATLY APPRECIATED.

Name of Reference:

Organization:

Title:

Telephone: E-mail:

Signature: Date: