Attachment_D_Past_Performance_Questionnaire_Solicitation_NSC-GEN-R-18-0015.pdf

Page 1 of 6 Ver: June 18, 2008

Acquisition Sensitive

Past Performance Questionnaire

Past Performance Survey

SOLICITATION NUMBER: ATTACHMENT #

A. Respondent/Agency Information

Firm/Agency Installation:

Typed/Printed Name of Respondent:

Signature of Respondent:

Title:

Phone No.

Email:

Contract/Project/Task Order Information. Complete the general contract information below:

Project Title/Brief Description of Work:

Name of Firm/Contractor:

Contract/Task Order Number:

Contract Type:

Total Dollar Amount of Contract (Base/Options):

Performance Period:

Type of Labor Used:

Completion Date(s):

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The below survey should be completed and emailed to or faxed to (202) 395-3982:

B. Past Performance Survey: For the purposes of this survey. the government will receive an overall assessment of how well the Contractor can perform in accordance with the solicitation requirements using the ratings below. In responding to the survey. please justify and explain exceptional, marginal, and unsatisfactory ratings.

Respondent may be contacted to clarify comments or ratings. In order for the government to review and assess the contractor's past performance rating, please use the following ratings to describe the offeror's performance on your contract or project.

Exceptional: Based on the Offeror's past performance history, the Offeror's performance exceeds specified performance capabilities. Past performance demonstrates benefit to the Government with no quality issues. No potential exists for disruption of schedule, increase in cost, or degradation of performance.

Highly Acceptable: Based on the Offeror' s past performance history, the Offeror's performance exceeds some contractual requirements while meeting other contractual requirements. Past performance demonstrates benefit to the Government with minor quality issues that do not impact achievement of contract requirements. Minimal potential exists for disrupt ion of schedule, increase in cost, or degradation of performance.

Acceptable: Based on the Offeror' s past performance history, the Offeror' s performance meets all contractual requirements. Past performance demonstrates some quality problems that do not impact achievement of contract requirements. Some potential exists for disrupt ion of schedule, increase in cost, or degradation of performance.

Marginal: Based on the Offeror's past performance history , the Offeror' s performance meets some contractual requirements and fails in others. Past performance demonstrates nonconformance that requires Agency monitoring to ensure achievement of contract requirements. Significant potential exists for disruption of schedule, increase in cost or degradation of performance.

Unacceptable: Based on the Offeror's past performance history, the Offeror' s performance clearly fails to meet minimum contractual requirements. Past performance demonstrates noncompliances that may compromise the achievement of contract requirements. Significant potential exists for disruption of schedule, increase in cost, or degradation of performance.

Unknown: No record of past performance or the record is inconclusive.

SOLICITATION NUMBER: ATTACHMENT #

Page 3 of 6 Ver: June 18, 2008

SOLICITATION NUMBER: ATTACHMENT #

Management Effectiveness

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

NARRATIVE:

NARRATIVE:

Quality and Timeliness

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

NARRATIVE:

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

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SOLICITATION NUMBER: ATTACHMENT #

NARRATIVE:

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

NARRATIVE:

Customer Satisfaction

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

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SOLICITATION NUMBER: ATTACHMENT #

NARRATIVE:

NARRATIVE:

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

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SOLICITATION NUMBER: ATTACHMENT #

Please provide explanation:

General Questions

No Yes

NARRATIVE:

Exceptional Marginal Acceptable Unacceptable Highly Acceptable Unknown

Additional comments:

Printed Name: Date:

Signature

Page of Ver: June 18, 2008 Acquisition Sensitive Past Performance Questionnaire Past Performance Survey A. Respondent/Agency Information Contract/Project/Task Order Information. Complete the general contract information below:

The below survey should be completed and emailed to or faxed to (202) 395-3982:

B. Past Performance Survey: For the purposes of this survey. the government will receive an overall assessment of how well the Contractor can perform in accordance with the solicitation requirements using the ratings below. In responding to the survey. please justify and explain exceptional, marginal, and unsatisfactory ratings.

Respondent may be contacted to clarify comments or ratings. In order for the government to review and assess the contractor's past performance rating, please use the following ratings to describe the offeror's performance on your contract or project.

Exceptional: Based on the Offeror's past performance history, the Offeror's performance exceeds specified performance capabilities. Past performance demonstrates benefit to the Government with no quality issues. No potential exists for disruption of schedule, increase in cost, or degradation of performance.

Highly Acceptable: Based on the Offeror' s past performance history, the Offeror's performance exceeds some contractual requirements while meeting other contractual requirements. Past performance demonstrates benefit to the Government with minor quality issues that do not impact achievement of contract requirements. Minimal potential exists for disrupt ion of schedule, increase in cost, or degradation of performance.

Acceptable: Based on the Offeror' s past performance history, the Offeror' s performance meets all contractual requirements. Past performance demonstrates some quality problems that do not impact achievement of contract requirements. Some potential exists for disrupt ion of schedule, increase in cost, or degradation of performance.

Marginal: Based on the Offeror's past performance history , the Offeror' s performance meets some contractual requirements and fails in others. Past performance demonstrates nonconformance that requires Agency monitoring to ensure achievement of contract requirements. Significant potential exists for disruption of schedule, increase in cost or degradation of performance.

Unacceptable: Based on the Offeror's past performance history, the Offeror' s performance clearly fails to meet minimum contractual requirements. Past performance demonstrates noncompliances that may compromise the achievement of contract requirements. Significant potential exists for disruption of schedule, increase in cost, or degradation of performance.

Unknown: No record of past performance or the record is inconclusive.

Management Effectiveness Quality and Timeliness Customer Satisfaction General Questions 8.0.1291.1.339988.308172