Attachment_L-1_Past_Performance_Questionnaire.pdf

HQ-NRL 4335/1 (Rev. 8-05) (Front)

PAST PERFORMANCE REPORT

SOLICITATION NO.

N00173 -

I. CONTRACTOR IDENTIFICATION (Complete all information or mark N/A)

CONTRACTOR NAME SUBCONTRACTOR/CONSULTANT TO

CONTRACT NUMBER CONTRACT TYPE

PERIOD OF PERFORMANCE INITIAL CONTRACT COST/PRICE CURRENT CONTRACT COST/PRICE

DESCRIPTION OF SUPPLIES OR SERVICES PROVIDED

II. PREPARED BY

ORGANIZATION

NAME/TITLE TELEPHONE NUMBER

SIGNATURE DATE

III. RATING SCALE

RATING SCALE SCORING

EXCEPTIONAL - Exceeded many contractual requirements to the Government's benefit 4

VERY GOOD - Met contractual requirements and exceeded some to the Government's benefit 3

SATISFACTORY - Met contractual requirements 2

MARGINAL - Did not meet some contractual requirements 1

UNSATISFACTORY - Did not meet most contractual requirements 0

IV. PAST PERFORMANCE QUESTIONS

A. PERFORMANCE HISTORY

Rate questions in accordance with the rating scale above, as applicable, by selecting one of the numbers.

1. ADHERENCE TO CONTRACT DELIVERY SCHEDULES?

4 3 2 1 0 N/A

7. SUBMISSION OF REQUIRED PROPOSALS IN A TIMELY MANNER?

2. TIMELY SUBMISSION OF REQUIRED REPORTS AND DOCUMENTATION?

4 3 2 1 0 N/A

8. RESPONSIVENESS TO TECHNICAL DIRECTIONS AND/OR CONTRACT

CHANGE ORDERS?

3. ACCURACY AND COMPLETION OF REPORTS AND DOCUMENTATION?

4 3 2 1 0 N/A

9. TIMELY, ACCURATE, AND APPROPRIATE CONTENT OF PROBLEM

TRACKING/REPORTING DOCUMENTATION?

4. ABILITY TO SOLVE CONTRACT PERFORMANCE PROBLEMS WITHOUT

EXTENSIVE GUIDANCE FROM GOVERNMENT COUNTERPARTS?

4 3 2 1 0 N/A

10. EFFECTIVENESS IN INTERFACING WITH GOVERNMENT'S STAFF?

5. DISPLAYED INITIATIVE IN MEETING REQUIREMENTS?

4 3 2 1 0 N/A

11. ADHERENCE TO THE KEY PERSONNEL REQUIREMENTS THROUGHOUT

THE PERFORMANCE OF THE CONTRACT?

6. COMMITTED ADEQUATE RESOURCES TO THE CONTRACT TO MEET THE

REQUIREMENT AND TO SUCCESSFULLY SOLVE PROBLEMS?

4 3 2 1 0 N/A

12. EFFECTIVE COORDINATION AND INTEGRATION OF SUBCONTRACTOR

MANAGEMENT?

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104

4 3 2 1 0 N/A

4 3 2 1 0 N/A

4 3 2 1 0 N/A

4 3 2 1 0 N/A

4 3 2 1 0 N/A

4 3 2 1 0 N/A

B. TERMINATION HISTORY

1. HAS THE CONTRACT BEEN PARTIALLY OR COMPLETELY TERMINATED FOR DEFAULT OR CONVENIENCE? (If yes, explain below (e.g., inability to meet cost, performance, or delivery schedules.))

No Yes: Default Convenience

EXPLAIN "YES" ANSWER:

2. ARE THERE ANY PENDING TERMINATIONS? (If yes, explain and indicate the status below.)

No Yes

EXPLAIN "YES" ANSWER:

C. COST HISTORY

1. ADHERENCE TO THE ORIGINAL COST ESTIMATES/TARGETS?

No Yes

2. DID THE CONTRACTOR OVERRUN OR UNDERRUN THE CONTRACT AMOUNT? (If yes, explain reason for cost overrun or underrun below.)

Overrun UnderrunNo Yes:

EXPLAIN "YES" ANSWER:

WOULD YOU SELECT THIS FIRM AGAIN? (Explain)

HQ-NRL 4335/1 (Rev. 8-05) (Back)

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104