Attachment_4_Past_Performance_Questionnaire.doc

Solicitation # N00024-xx-x-xxxx

NAVAL SEA SYSTEMS COMMAND

SOURCE SELECTION

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO EVALUATORS

The evaluation of an Offeror’s past performance is essential and integral to our source selection process. Accordingly, we respectfully request your candid assessment of the Offeror’s past performance.

Once completed, this questionnaire and any appended information becomes SOURCE SELECTION SENSITIVE and must be protected from disclosure. Access to this information shall be limited to Government procurement officials. Please do not provide completed questionnaires to the Offeror.

Please ensure that the completed questionnaire is received at the following address no later than 20 May 2002:

Outside envelope:

COMMANDER

SEA 02413, ROOM 5W-1648

NAVAL SEA SYSTEMS COMMAND

1333 ISAAC HULL AVENUE SE STOP 2030

WASHINGTON NAVY YARD DC 20376-2030

DO NOT OPEN IN MAIL ROOM

Inner envelope:

ATTN: Mr. Fred M Pohlmann (Code 02413, Room 5W-1648)

RFP N00024-10-R-4118

Telephone Number:

(202) 781 - 5155 Fascimile:

(202) 781 – 4637

E-mail:

fred.pohlmann@navy.mil Handwritten responses are acceptable. All responses must relate solely to the Contractor and the contract, task, or order identified. Please answer each question by checking the box located beside the appropriate rating. In addition, please provide supporting comments for each rating, including supporting comments to highlight the Contractor’s specific strengths and weaknesses. You may use additional sheets, if required. Your ratings and comments should reflect only “Contractor liable” performance. You may supplement your knowledge with the knowledge and judgement of others in your organization.

Please enter the requested information, then transmit the completed questionnaire to the above address. Thank you for your assistance in this matter.

PAST PERFORMANCE QUESTIONNAIRE

CONTRACTOR:

ADDRESS OF CONTRACTOR:

CONTRACT NUMBER:

TASK ORDER NUMBER (if applicable):

CONTRACT TYPE:

ORIGINAL CONTRACT VALUE:

CURRENT CONTRACT VALUE:

PERIOD OF PERFORMANCE:

PLACE OF PERFORMANCE:

DESCRIPTION AND SCOPE OF EFFORT: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

POC NAME:

ADDRESS:

TELEPHONE NUMBER:

FASCIMILE NUMBER:

METHOD SENT TO POC:

DATE SENT TO POC:

(To be completed by Evaluator)

PAST PERFORMANCE QUESTIONNAIRE

ADJECTIVAL RATINGS AND CRITERIA

NOTE: Evaluation of the Contractor’s performance shall be based on “objective” data and MUST INCLUDE SUPPORTING RATIONALE when ANY of the following ratings are used. Relate significant events to sub-factors where possible. Rationale should identify “HOW” the contractor met the sub-factor criteria under evaluation.

Exceptional: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the factor or sub-factor being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the factor or sub-factor being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory: Performance meets contractual requirements. The contractual performance of the factor or sub-factor contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal: Performance does not meet some contractual requirements. The contractual performance of the factor or sub-factor being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the factor or sub-factor contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Choose the letter that most accurately describes the Contractor’s performance on the contract listed in the attached pages. Please note that “E” represents Exceptional, “V” means Very Good, “S” stands for Satisfactory, “M” means Marginal, and “U” indicates Unsatisfactory. Choose “N/A” if the question is not applicable.

1. Overall Contract Outcome:

FORMCHECKBOX

E FORMCHECKBOX

V FORMCHECKBOX

S FORMCHECKBOX

M FORMCHECKBOX

U FORMCHECKBOX

N/A

Ability to satisfactorily complete all tasks while conforming to the customer requirements, standards of good workmanship, safe practices, compliance with contractual terms and conditions, responsiveness to procuring activity changes and ability to overcome program difficulties.

Comments:

2. Conclusion:

Would you award similar contracts to the Contractor in the future? FORMCHECKBOX

YES FORMCHECKBOX

NO

Comments:

What role did you play? Length of time spent performing that role?

(e.g. COR, Contract Specialist, ACO?)

NAME (Printed)/Phone

SIGNATURE

DATE

Please transmit in accordance with the instructions on the first page of this questionnaire.

Thank you for your participation!

SOURCE SELECTION INFORMATION ONCE COMPLETED

Attachment 4