Atch_6,_Past_Performance_Questionnaire.doc

Solicitation Number: N40339-17-R-S001

ATTACHMENT 6 – PAST PERFORMANCE QUESTIONNAIRE

Offeror’s Name: ______________________________________________

The completion of Part I of this questionnaire shall be completed by the offeror.

The completion of Part II of this questionnaire is requested from the respondent’s agency/company in order that NAVSUP FLC Bahrain may evaluate the aforementioned contractor’s past performance on previous contracts as it relates to the probability of successful accomplishment of the work required by NAVSUP FLC Bahrain relative to the award of the contract resulting from the solicitation.

The respondent shall 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. Offeror shall submit the completed questionnaire to the contracting office along with the solicitation package.

Offerors are required to submit this form as part of the solicitation. The questionnaire Part-II shall be completed by the past performance reference (who the offeror performed the work for) and shall be incorporated into the offeror’s past performance information.

The questionnaire shall be completed as provided. If required, only the spacing may be modified to accommodate the offeror’s or respondent’s comments.

PART I – TO BE COMPLETED BY OFFEROR

1. Contractor: _________________________________________________________________________

2. Contract number: ____________________________________________________________________

3. Point of contact/phone number and fax number at agency where the contract was performed:

Name: _______________________________________________________________________________

Telephone: ___________________________________________________________________________

Fax: _________________________________________________________________________________

Email:________________________________________________________________________________

4. Detailed description of the work performed:

5. Dollar value of contract: _______________________________________________________________

6. Period of Performance: ________________________________________________________________

7. Name(s) of subcontractors used, if any, and a description or work performed by the subcontractor(s):

PART II – TO BE COMPLETED BY THE RESPONDENT

1. Describe the work that the offeror performed for you under this contract.

2. Assessment Elements. Circle the appropriate letter for each item on the questionnaire (or if forwarding electronic copy via e-mail, “bold” the appropriate letter) and provide supporting narrative.

The definitions of the Acceptable /Unacceptable ratings are provided below:

Rating

Description

Acceptable (A)

Contractor successfully performed the required effort.

Unacceptable (U)

Contractor did not successfully perform the required effort.

Not Applicable (N)

Contractor performance record is unknown or not applicable.

(1) Achieving Contract Requirements: The offeror’s demonstrated history of delivering products and services met or exceeded the requirements of the contract.

· How would you describe your level of customer satisfaction?

A U N ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2) Timeliness.

· Did the Contractor meet/comply with performance schedules?

N

· Rate the timeliness of submission of requested information, reports and invoicing.

N

(3) Contractor Responsiveness. The offeror’s demonstrated ability to:

· Respond to customer concerns

N ________________________________________________________________________________________________________________________________________________________________________________________________________________________

· Isolate and resolve problems

· the number and severity of problems,

· the effectiveness of corrective actions taken.

N

· Contractor's cost control. Did the contractor deliver at the agreed-to price/cost? Describe the reasons for changes to contract value (e.g., scope changes, overrun/under-run, buyer-imposed schedule changes, etc.)

N

3. Please provide the name, title, address, and phone number of the person completing this questionnaire.

Phone _______________ FAX ___________________

Thank you for your assistance in this source selection. If you have any questions, please call Ms. Marietta S. Fry, +973-1785-3363, email: Marietta.fry@me.navy.mil Attachment 6