J2 Past Performance Questionnaire (3 Pages).pdf

ATTACHMENT J2 –PAST PERFORMANCE

QUESTIONNAIRE 030ADV26R0042 - Stereo Headphones

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _______________________________________

B. Agency Contract number: ____________________________________

C. Contract type: ______________________________________

D. Was this a competitive contract? Yes No

E. Period of performance: _________________

F. Contract cost or price: ___________________________________

G. Description of work: ____________________________________________________________________

Government Contracts Only: Was this contract partially or fully terminated for default or convenience or are there any pending terminations?

Default______ Convenience______ Pending Termination______

If any applies, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc):

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Geographic description of services under this contract, i.e. local, nationwide, worldwide:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name and title:

B. Evaluator's phone/fax number:

Number of years evaluator worked on subject contract: _____________________.

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor's performance by placing an "X" in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

• Not Applicable: N/A

• 1: Performance clearly below the contract performance standard or requirement

• 2: Performance occasionally does not meet minimum contract performance standard or requirement

• 3: Performance that meets the minimum contract performance standard or requirement

• 4: Performance that meets and occasionally exceeds the contract performance standard or requirement

• 5: Performance that almost always exceeds the contract performance standard or requirement

1. Overall satisfaction N/A 1 2 3 4 5 Overall satisfaction with performance. Would you (the reference) choose to work with this offeror again?

2. Quality N/A 1 2 3 4 5

Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.

3. Schedule N/A 1 2 3 4 5

Schedule includes delivery consistency, on-time performance, and flexibility in responding to emerging issues.

4. Cost/Price N/A 1 2 3 4 5

Cost/price refers to the offeror’s ability to manage the work within the agreed upon cost or price.

5. Personnel N/A 1 2 3 4 5

Rate the quality of the contractor’s staff in executing the project work scope.

6. Contract Management N/A 1 2 3 4 5

This includes quality and timeliness in sourcing, invoicing, and reporting under the contract.

7. Communication and problem resolution N/A 1 2 3 4 5

This includes the offeror’s ability to communicate and solve problems in a timely and effective manner.

SECTION 5: NARRATIVE SUMMARY

What were the contractor's greatest strengths in the performance of the contract?

What were the contractor's greatest weaknesses in the performance of the contract?

Did the contractor fulfill warranty or non-warranty repairs in performance of this contract? What kind of ongoing support and defect remediation did they provide and with what frequency was it necessary?

Would you hire this contractor in the future to perform one of your critical and demanding programs?

YES NO

Evaluator Signature: ________________________________ Date: __________________

Thank you for your prompt response and assistance!

Please return this completed questionnaire with the Subject: RFP 030ADV26R0042 to the Contracting Specialist, Brenda Kinlay at bkinlay@loc.gov with the following copied:

Contracting Officer: Brian Curl, BCurl@loc.gov

The purpose of this questionnaire is to gather information on the contractor named below to determine their suitability to provide services for the Library of Congress (Library). Your prompt completion of this questionnaire is sincerely appreciated as it is critical to the completion of the proposal evaluation process. Any information provided on this Questionnaire may, or may not be, anonymous (specifically in regards to whether the information you provide to the Government will be seen by the business under evaluation). However, your honest feedback is highly valuable and appreciated despite this.

mailto:bkinlay@loc.gov mailto:jarobinson@loc.gov