16-R-3501_ATT_O.doc

N32205-16-R-3501 ATTACHMENT O: PAST PERFORMANCE DATA

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Current status of contract (choose one):

[ ] Ongoing

[ ] Complete

[ ] Terminated for Convenience

[ ] Terminated for Default

[ ] Other (explain)

12. Provide a summary description of contract work. Describe the scope and complexity of work, its relevancy to the efforts to be performed under this solicitation and a description of any problems encountered and your corrective actions. Additional details, to include past performance information regarding predecessor companies, key personnel who have relevant experience and subcontractors that will perform major or critical aspects of the requirement can be attached to this form, but shall not exceed two (2) pages in length.

13a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes __, No__.

13b. If “Yes” to 13a, have you regularly submitted your reports in the Electronic Subcontract Reporting System (ESRS) in a timely manner? Yes __, No__.

If no, why not?

14. Address historical compliance with the requirements of FAR Part 52.219-8 (Utilization of Small Business Concerns) for Government contracts. Large businesses: Address historical compliance with the requirements of FAR 52.219-9 (Small Business Subcontracting Plan) and DFARS 252.219-7003 (Small Business Subcontracting Plan, DOD Requirements).

PERFORMANCE QUESTIONNAIRE

TO:

FACSIMILE:

PHONE:

EMAIL:

INFORMATION REQUEST

Military Sealift Command (MSC) is currently in the process of soliciting offers for a contract. ____________________ has provided your name and organization as a reference regarding their record of past performance under Contract No. ___________________. Specifically, we are looking for performance information in the following areas:

a) Quality of Product or Service

b) Timeliness or Scheduling of Service/Deliveries

c) Business Relations/Customer Satisfaction

d) Key Personnel and Staffing (Including Subcontractors)

In order for our team to compile its evaluation, we request that you complete the attached questionnaire and email it, and any other pertinent information, by BEFORE THE CLOSING DATE OF THIS SOLICITATION (02:00 PM EST 12/14/2015) to Cori Kirkbride. Information can also be sent via facsimile to the attention of Cori Kirkbride @ 757-443-1506. Any relevant information you have would be vital in our assessment of the aforementioned Contractor.

Thank you, Cori Kirkbride

Contract Specialist

For your convenience, a cover sheet for use in mailing/faxing is provided below.

471 East C Street, Building SP-64 Norfolk, VA 23511

From:

(Name and Address of Organization)

(Point of Contact Name)

(Facsimile/Phone Number)

(E-mail Address)

To (Point of Contact Name)

Cori Kirkbride (Facsimile Number)

(757) 443-1506 (E-mail Address) cori.kirkbride@navy.mil

CONTRACTOR PERFORMANCE QUESTIONNAIRE

CONTRACTOR NAME:

CONTRACT NUMBER:

EVALUATION PERIOD:

DELIVERY ORDER NO.:

1.

Please describe the service/supply provided by the Contractor for your organization.

2. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional, Very Good, Satisfactory, Marginal, or Unsatisfactory. See next page for definition of ratings. For ratings of “Exceptional” or “Unsatisfactory,” please provide a brief explanation.

OVERALL PERFORMANCE RATING

Please provide an overall rating of the Contractor’s performance for the referenced contract/delivery order.

a.) Quality of Product or Service: Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence b.) Timeliness or Scheduling of Supplies/Deliveries: Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction: Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business subcontracting program and satisfaction with Contractor’s service.

d.) Key Personnel and Staffing (Including Subcontractors): Qualified personnel, effective performance and conduct.

e) Cost Control (COST CONTRACTS ONLY): Actual cost / rates reflect closely to negotiated cost / rates, adequate budgetary internal controls, current, accurate and complete billings

3. Would you hire this Contractor to provide supplies/services for your organization in the future? Yes FORMCHECKBOX No FORMCHECKBOX Please provide comments using additional pages if desired.

Signed:__________________________________

DEFINITION OF RATINGS FOR PAST PERFORMANCE

N32205-16-R-3501 Attachment O