Past-Performance-Questionnaire_(_5).doc

M0026313T1017

ATTACHMENT #5

PAST PERFORMANCE QUESTIONNAIRE TEMPLATE

Instructions:

· Sections I through III to be completed by the Offeror and provided to Chris Wendle. The assessor, in turn, to verify Sections I through III, complete the questionnaire, and submit to the Contracting Office. The Offeror should also submit with its proposal (by the closing date of the Solicitation) copies of Sections I and II of all questionnaires as provided to assessors.

· Section II to be validated by the assessor. If any information is incorrect herein, please annotate and provide the correct information accordingly.

· Sections III through VII to be completed in their entirety by the assessor.

Message to the assessor: Your assistance is requested by the USMC to assist with establishing the performance history for the Contractor named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed questionnaire(s) to: christine.wendle@usmc.mil or fax to 843-228-4344.

I. Solicitation Data (for the proposed effort)

II. Current or Historical Contract Information

Assessor: The performance data submitted by the Offeror is FORMCHECKBOX

FILLIN \* MERGEFORMAT correct or FORMCHECKBOX incorrect.

CONTRACTOR NAME & ADDRESS:

Contract No

Type of Contract

Contract Value

Period of Performance/Delivery Schedule

Project/Requirement Description

Please select from the following as it applies to this contract:

PRIME

FORMCHECKBOX

SUBCONTRACTOR

Convenience

FORMCHECKBOX

Default

FORMCHECKBOX

N/A

III. Assessor Information

Assessor Name

Title

Phone Number/Email Address

Identify your role in the contract award or administration and the period of your involvement.

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO)

Contract Specialist

Contracting Officer’s Representative (COR)

Technical Project Lead/Project Officer

Quality Assurance Specialist

Defense Contract Audit Agency (DCAA) Auditor

Other:

IV. Evaluation Definitions

The following definitions should be used in your assessment of Contractor performance.

V. Performance Evaluation

1. Technical Performance

a. What is your OVERALL assessment of the quality of the contractor’s performance?

Technical Performance

Please provide rationale for the assigned rating.

b. Assess the Contractor’s technical performance in the following areas.

Durability / Quality

Appearance

Delivery

Installation

Warranty

Warranty Claims

All comments are appreciated; however, at a minimum, rationale must be provided for ratings of exceptional or unsatisfactory.

c. Did the Government contribute in any way to problems associated with quality as identified in the above assessment? Please explain.

2. Schedule Performance

a. What is your OVERALL assessment of the Contractor’s ability to meet the delivery and installation requirements?

Schedule Performance

Please provide rationale for assigned rating.

b. Did the Government contribute in any way to any of the Schedule problems identified in the above assessment? Please explain.

3. Customer Service

All comments are appreciated; however, at a minimum, rationale must be provided for ratings of exceptional or unsatisfactory.

VI. Overall Rating of Contractor’s performance (technical, delivery, installation, management, and cost) on contract being assessed.

VII. General Comments:

a. Would you hire this Contractor again? Yes or No

b. If no, please explain why.

Assessor’s Signature

Date Source Selection Information – See FAR 2.101 and FAR 3.104 For Official Use Only