DRAFT Attachment 3 - Past Performance Questionnaire.docx

Department of the Army U.S. Army mission and installation contracting command MICC-Fort Eustis 705 Washington Boulevard, Suite 126 FORT Eustis, VA 23604-5292

Date

SUBJECT: Offeror Past Performance Questionnaire in Support of Request for Proposal (RFP) W9124G24R0001

Dear Sir/Ma’am, The US Army, Mission and Installation Contracting Command (MICC) – Fort Eustis, is currently conducting a competitive source selection to evaluate Offerors on the subject RFP. As part of this evaluation, we have requested that the Offerors provide information about their past performance on recent and relevant federal, state, or local government or commercial contracts as compared to solicitation W9124G24R0001. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation. Please complete the enclosure and return to MICC – Fort Eustis, no later than 3 days after receipt of request or by 10:00 AM EDT on MMMM DD, YYYY, whichever occurs first. Please Submit your completed questionnaire to Contracting Officer, Mr. David Clark, david.m.clark210.civ@army.mil, and Contract Specialist Miss Hunter Langdon, hunter.m.langdon.civ@army.mil.

Your cooperation is greatly appreciated. Questions may be directed to the individuals identified above.

Sincerely, [ORIGINAL SIGNATURE ON FILE]

DAVID M. CLARK

Contracting Officer

Past Performance Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does and notify the Contracting Officer. Please return the completed Questionnaire to the points of contact identified in the cover letter within the stated timeframe.

Rating Definitions:

Exceptional: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unacceptable: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

PART I. (To be completed by the Offeror competing for the requirement)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

B. IDENTIFICATION OF OFFEROR’S COMPANY REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

E-mail Address:

PART II. EVALUATION (To be completed by Respondent Point of Contact) *Note: rationale is required for each response.

A. Effectiveness of Staffing and Management Plan to Provide Qualified Personnel to Deliver Service Outcomes that Met Requirements

|_| Exceptional |_| Very Good |_| Satisfactory |_| Marginal |_| Unacceptable

Rationale: _________________________________________________________

B. Effectiveness to Provide a Stable Contractor Workforce that Minimizes Disruption to Contract Performance.

|_| Satisfactory |_| Marginal |_| Unacceptable

Rationale: __________________________________________________________

C. Effectiveness to Provide Qualified Personnel to Support Surge/Short Requirements Through Recruitment or Cross Utilization Without Disrupting Support to Ongoing Requirements.

|_| Satisfactory |_| Marginal |_| Unacceptable

Rationale: __________________________________________________________

D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest (to include contract administration and management support)

|_| Satisfactory |_| Marginal |_| Unacceptable

Rationale: __________________________________________________________

E. General Comments. Provide any other relevant performance information. Continuation pages are welcomed.

Comments: _________________________________________________________

F. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name): __________________________________________ Telephone Number: ______________________________________________

G. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the points of contact identified in the cover letter. Thank you for your assistance.

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