Att.9_-_Past_Performance_Questionnaire.docx

Please complete this questionnaire and send by facsimile to the attention of John E. Lynch at 407-381-8817.

Required Response Date: No later than 12:00 p.m. EST XX January 2013

When completed, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1. A. NAME & ADDRESS OF CONTRACTOR BEING EVALUATED:

B. CONTRACTOR BEING EVALUATED

PERFORMED AS PRIME CONTRACTOR,

SUB-CONTRACTOR OR KEY PERSONNEL

FOR CONTRACT IN #2?

C. IF B WAS OTHER THAN PRIME

CONTRACTOR, NAME & ADDRESS

OF PRIME CONTRACTOR FOR CONTRACT

IN #2:

2. CAGE CODE OF CONTRACTOR BEING

EVALUATED:

3. CONTRACT NO.

4. CONTRACT INITIATION DATE:

5. COMPLETION DATE:

6. CONTRACT TYPE:

7. INITIAL CONTRACT PRICE:

8. CURRENT CONTRACT VALUE:

9. PERIOD OF PERFORMANCE:

10. DESCRIPTION OF CONTRACT REQUIREMENTS (Please add a continuation page if additional space is necessary):

TO BE COMPLETED BY EVALUATING ORGANIZATION / REPRESENTATIVE

11. EVALUATOR INFORMATION:

a) Evaluator’s name, position, and organization:

b) Evaluator’s phone number and email address:

c) Months of performance monitored by evaluator:

12. EVALUATION:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

EX = Exceptional VG = Very Good S = Satisfactory MG = Marginal US = Unsatisfactory N/O = Not Observed

A. Quality of Products or Services – Assess the contractor’s conformance to contract requirements.

EX VG S MG US N/O

B. Performance – Assess the contractor’s performance for the project.

EX VG S MG US N/O

C. Schedule – Assess the timeliness and flexibility of the contractor against the schedule and changes.

EX VG S MG US N/O

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

EX VG S MG US N/O

E. Personnel Retention & Recruitment – Assess the contractor’s ability to hire, retain and/or replace personnel.

EX VG S MG US N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

EX VG S MG US N/O

G. Overall Assessment

EX VG S MG US N/O

TO BE COMPLETED BY EVALUATING ORGANIZATION / REPRESENTATIVE

13. ADDITIONAL COMMENTS:

A. CONTRACT IDENTIFICATION

1. Was this a competitive contract? Yes ____ No __ _

2. Reason(s) for difference between initial contract price and current/final contract price, if any:

B. RESPONDENT INFORMATION:

1. Name:

2. Title:

3. Telephone Number:

4. FAX Number:

5. Email Address:

M67854-13-R-7803 Attachment 9

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection