2.04s Attachment

Source Selection Plan

PAST PERFORMANCE QUESTIONNAIRE

TO BE COMPLETED BY THE RESPONDENT AND RETURNED TO FLC PH

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

A. The completion of this questionnaire is requested from your agency/company to assist with establishing the performance history for the Contractor named below. This questionnaire will be utilized by NAVSUP Fleet Logistic Center Pearl Harbor 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. 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: jeen.chu@navy.mil or fax to 808-473-3524.

Solicitation Data (for the proposed effort)

Company's Name:

POC/Title/Position/Role:

POC/Title/Position/ Role:

Contract/Purchase Order No.

Contract Value:

Contract Type:

Period of Performance:

Business Address:

Phone Number:

Email Address:

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

Contracting Role

PRIME

SUBCONTRACTOR

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

B. Explanation of codes:

Performance Ratings

C. Check the appropriate code for each item on the questionnaire and provide supporting narrative. At a minimum, rationale must be provided for ratings of unsatisfactory.

1. Rate the Offeror’s Quality of Performance:

(i) Overall satisfaction with the Offeror:

FORMCHECKBOX

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

FORMCHECKBOX

N Please provide rationale for the assigned rating.

b. Assess the Contractor’s quality of performance in the following areas.

Conformance to Contract Requirements

Conformance to Specifications

Standards of Good Workmanship (technical, professional, environmental, safety, etc.)

(iii) Instances of rework and/or deficiency reports:

FORMCHECKBOX

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

(iv) Effective and/or innovative work applications that were beneficial to you:

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

2. Rate the Offeror’s Schedule Performance:

(i) Timeliness in completion of delivery and/or performance schedules. What were the causes of any delay?

FORMCHECKBOX

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

(ii) Timeliness in submitting deliverables such as requested information, reports, and invoicing:

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

3. Rate the Offeror’s Responsiveness:

(i) Demonstrated ability to respond to your concerns, isolate and resolve problems and take systemic improvement action:

FORMCHECKBOX

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

(ii) Did the product meet the required level of quality?

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

(iii) What is your overall rating of the contractor’s performance (technical, schedule, management, and cost)?

G

FORMCHECKBOX

A

FORMCHECKBOX

M

FORMCHECKBOX

UA

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

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

F. 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.

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

Assessor’s Signature

Date SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104

For Official Use Only Attachment (3)