2.04a Attachment 1 - Past Performance Questionnaire.pdf

PAST PERFORMANCE

QUESTIONNAIRE N68836-24-R-0003

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor:

B. Cage Code:

C. Contract number:

D. Contract type:

E. Was this a competitive contract? Yes ____ No _____

F. Period of performance:

G. Initial contract cost:

H. Current/final contract cost:

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

D. Number of years evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

US UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

NA NOT APPLICABLE - Unable to provide a score.

Place an ''X" in the appropriate column using the definitions above.

The Contractor: E VG S M US NA

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Home office participated in solving significant local problems.

5. Followed approved quality control plan.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in a timely manner and pursuant to their quality control procedures.

8. Provided timely resolution of contract discrepancies.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Was responsive to contract changes.

13. Provided adequate project supervision.

14. Paid subcontractors/suppliers in a timely manner.

15. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

16. Provided services or completed task orders in accordance with the delivery schedule?

17. Cooperated with Government personnel after award.

18. Submitted accurate and timely reports.

19. Submitted all deliverables in accordance with the contract delivery schedule.

20. Handled both scheduled and unscheduled surges (increased workload) while controlling costs?

21. Submitted current, accurate, and complete billings?

22. How would you rate the contractor's overall performance?

23. Ability to meet or exceed small business and small disadvantaged business goals set forth in the approved subcontracting plan.

24. Ability to effectively manage small business participation to meet technical performance.

25. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in "Comments."

26. Would you award another contract to this company?

1. Please discuss each and every response for which you indicated E (Exceptional), M (Marginal) or US (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

2. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes____ Default____ Convenience____ Pending Terminations____ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

E-mail to: Mrs. Maria Brophy and Mr. Daniel Arnold at maria.n.brophy.civ@us.navy.mil and daniel.r.arnold30.civ@us.navy.mil mailto:dwayne.k.davis@navy.mil mailto:worner.heath1@navy.mil