J-4-2_Past Performance Questionnaire_Revised.docx

S/GAC IDIQ Solicitation Attachment J-xx — Past Performance Questionnaire

Attachment J-4-2 Past Performance Questionnaire

NOTE: For each Past Performance Contract Profile submitted, the Offeror must submit this Attachment.

PAST PERFORMANCE PROJECT IDENTIFICATION (To be filled out by the Offeror):

PAST PERFORMANCE REFERENCE INFORMATION (To be filled out by the Rater):

Any questions concerning completion of this form should be addressed to maysjr@state.gov.

INSTRUCTIONS

This questionnaire is to be completed as indicated below. For purposes of these evaluations, the term “client engagement” is intended to mean “contract”. This package consists of the following:

Past Performance Questionnaire

S/GAC Acquisition Solicitation # 19AQMM23R0059

When completed, this document contains procurement sensitive information.

SECTION 1A: CLIENT ENGAGEMENT PROFILE

(To be completed by the Offeror and verified by the Client Point of Contact (POC)) Client Organization Name:

U.S. Federal Government Department and Agency (if applicable)

Contractor Name:

Subcontractors and Partners (if any):

Contract Type:

(e.g., Time and Materials, Fixed Price, Unit-based, Asset-based, etc. or Combination/Hybrid) Please explain fully.

No

Total period of performance, including options: (MM/YYYY - MM/YYYY or MM/YYYY – Present)

Summary Description of Services Provided:

Geographic Coverage of Services for This Contract:

(e.g., Local, National, Global)

Project size (e.g., the number of employees and various departments in the organization for which work was performed/is being performed)

Project complexity (e.g., the multiple dimensions/business units/departments for which an IT budget was developed)

SECTION 1B: ENGAGEMENT RELEVANCY TO THE FUNCTIONAL CATEGORY’S CAPABILITIES

(To be completed by the Offeror and verified by the Client POC). Please indicate which of the following capabilities this Past Performance Survey addresses (more than one can be indicated, if applicable). If the Offeror believes that a capability related to this category is relevant but is not represented by the ones already listed, please enter it in the space designated in the table below:

Support Services

SECTION 2: CLIENT IDENTIFICATION

(To be completed by the Reference POC) POC Name:

Reference POC Title/Position:

Reference POC Email Address:

Reference POC Phone Number:

Number of years the Reference POC was associated with this engagement:

Is Section 2 of this questionnaire accurate?

If No, please explain:

Yes/No

SECTION 3: EVALUATION

Evaluation — Please indicate your satisfaction with the service provider’s performance by placing a “X” in the appropriate block using the rating scales to the right of each dimension. Additionally, if desired, please provide a narrative explanation to support your ratings. At a minimum, for any Marginal or Unsatisfactory rating, please submit additional comments to substantiate the rating. For any rating that is checked Not Applicable, please explain why it does not apply.

1. QUALITY OF SERVICE

ADDITIONAL COMMENTS:

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2. SCHEDULE

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3. COST CONTROL

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4. BUSINESS RELATIONS

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5. MANAGEMENT OF KEY PERSONNEL

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SECTION 4: PAST PERFORMANCE SUMMARY

Provide an overall rating for the Contractor using the evaluation rating scale below.

On a scale of 1 to 5, how likely would you be to use the Contractor again?

If you have any further information that was not covered by this questionnaire, but you feel is important, please provide this information

Client POC’s Signature

Date