PAST_PERFORMANCE_QUESTIONNAIRE.rtf

ATTACHMENT 3

PERFORMANCE INFORMATION QUESTIONNAIRE

MILITARY SEALIFT FLEET SUPPORT COMMAND

N106-GENERAL CONTRACTS

CONTRACTING OFFICER: CHERYL SOMERS

CONTACT INFO: TEL. 757-443-5921; EMAIL: CHERYL.SOMERS@NAVY.MIL

SOLICITATION: N40442-10-R-6006

DATE:

OFFEROR: ___________________________

1. Instructions to offerors: Please complete the following information prior to providing this questionnaire to your reference for evaluation of performance. Note, the questionnaire must be submitted directly from the offeror’s reference, not from the offeror:

1) Contract or purchase order number (s):

2) Name, phone number and e-mail of the point of contact at the Federal, State, Local Government, or Commercial entity for which the contract was performed:

3) Dollar value of the contract:

4) Actual dollar value paid under the contract:

5) Estimated number of rooms utilized and duration:

6) Names of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s),

2. Instruction to Offeror’s Reference: The Military Sealift Fleet Support Command, N106, is conducting evaluations of the offeror identified above. We would appreciate your assessment of the performance of this contractor on page 3 of this evaluation sheet, giving detailed narrative when possible. Upon completion of the document please submit directly to the contracting officer, Ms. Cheryl Somers. Documents may be scanned and emailed to cheryl.somers@navy.mil. Please contact Ms.Somers at (757) 443-5921 should you have any questions concerning the questionnaire.

a. EVALUATION CHARACTERISTICS (Please use the following grading scale when rating the offeror; please provide examples when necessary):

1. Unsatisfactory/High Performance Risk: High potential risk anticipated with delivery of quality product/service on time and/or of customer dissatisfaction based on the offeror’s past performance.

2. Satisfactory/Little or no Performance Risk: Little risk anticipated with delivery of quality product/service, on time, and/or of customer dissatisfaction based on offeror’s past performance.

3. Neutral: No relevant past performance available for evaluation. Offeror has asserted that it has no relevant or directly related similar past performance experience.

Proposal receives no merit or demerit for this factor.

a. Quality of product or service: _______________________________________________________________________________________

b. Timeliness or scheduling of service/deliveries: _______________________________________________________________________________________

c. Business relations/customer satisfaction (generally, the contractor’s business like concern for the interest of the customer): _______________________________________________________________________________________

d. Contractor’s record of conforming to specifications and to standards of good workmanship: ______________________________________________________________________________________

e. Contractor’s record of forecasting and containing costs on previously performed contracts: ______________________________________________________________________________________

f. Contractor’s adherence to contract schedules, including the administrative aspects of contract performance: ______________________________________________________________________________________

g. Contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction: ______________________________________________________________________________________ and

Overall Rating: ___________________________

Submitted by: ___________________________

Job Title: _______________________________

Company Name: _________________________

Tel #: __________________________________

Date: __________________________________