Attachment_5_-_Past_Performance_Report_Form.doc

PAST PERFORMANCE REPORT FORM

TO BE COMPLETED BY THE RESPONDENT AND RETURNED TO NAVSUP FLCN

(PLEASE DO NOT RETURN TO THE CONTRACTOR WHO ORIGINATED THIS REQUEST)

A. The completion of this questionnaire is requested from your agency/company in order for the NAVSUP Fleet Logistics Center Norfolk to evaluate the aforementioned contractor’s past performance on previous contracts as it relates to the probability of successful accomplishment of the work required by the Government relative to the award of the contract resulting from the solicitation.

Please provide concise comments regarding your overall assessment of the contractor’s performance on the contract identified below. Please respond to each question in a narrative format. Please mail, fax, or e-mail your completed questionnaire directly to the address below:

Commanding Officer

NAVSUP Fleet Logistics Center Norfolk Contracting Department, Attn: Ricardo Lopez Code: 245.3 1968 Gilbert Street Suite 600

Norfolk, VA 23511-3392

Phone: (757) 443-1926 Fax: (757) 443-1424

Email: ricardo.a.lopez4@navy.mil

Company's Name _________________________________

POC/Title/Position: ________________________________

Email Address: ___________________________________

Contract/Purchase Order No._______________________

Contract Amount: _________________________________

Contract Type: ___________________________________

Period of Performance: ____________________________

Business Address____________________________________________________

Phone Number __________________

1. Quality:

(i) Describe satisfaction with the Offeror

(ii) Describe instances of rework and/or deficiency reports

(iii) Describe effective and/or innovative work applications that were beneficial to you

2. Timeliness:

(i) Describe offorors demonstrated ability to comply with: delivery and/or performance schedules. What were the causes of any delay?

(ii) Describe timeliness of submission of requested information, reports, and invoicing

3. Responsiveness:

(i) Describe Offeror’s demonstrated ability to respond to your concerns.

(ii) Describe Offeror’s efforts to isolate and resolve problems and take systemic improvement action.

4. Identify the contractor's overall strengths and weaknesses.

5. Given the choice, would you award to this contractor again?

6. Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.

7. Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.