Past Performance. Questionnaire.pdf

ORGANIZATION’S PERFORMANCE QUESTIONNAIRE

ORGANIZATION’S PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection

Please complete this questionnaire and email to: rodney.a.johnson77.civ@mail.mil, and keta.s.peterson.civ@mail.mil

Keta Peterson, Contracting Officer Rodney Johnson, Contract Specialist Defense Media Activity Same address as CO 6700 Taylor Ave Fort Meade, MD 20755

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY CONTRACTOR

1. CONTRACTOR’S NAME AND

ADDRESS

4. CONTRACT NO.:

5. CONTRACT INITIATION DATE:

6. COMPLETION DATE:

7. CONTRACT VALUE $

2. PROJECT NAME:

8. TYPE OF CONTRACT:

9. DESCRIPTION OF PROJECT’S KEY CHARACTERISTICS:

Please add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

10. EVALUATION

a. EVALUATOR’S NAME, POSITION DURING PROJECT EXECUTION (Project

Manager/COR/Other) AND ORGANIZATION

b. EVALUATOR’S PHONE NUMBER

c. MONTHS PERFORMANCE

MONITORED BY EVALUATOR:

Please check the response code for each topic that best reflects your experience with this contractor:

EX = Exceptional VG = Very Good S = Satisfactory MG = Marginal US = Unsatisfactory N/O = Not Observed

A. Quality of Products and Services- Assess the contractor’s conformance to contract requirements.

EX VG S MG US N/O

B. Overall Performance- Assess the contractor’s overall performance for the project.

EX VG S MG US N/O

mailto:rodney.a.johnson77.civ@mail.mil

C. Schedule- Assess the timeliness of the contractor against the schedule of activities (as appropriate).

EX VG S MG US N/O

D. Technical Requirements- Assess the contractor’s ability and capacity to fulfill the technical requirements of the contract.

EX VG S MG US N/O

E. Cost Control- Assess the contractor’s willingness and ability to manage the contract budget and control costs.

EX VG S MG US N/O

F. Subcontracting- Assess the contractor’s success at complying with subcontracting goals.

EX VG S MG US N/O

G. Customer Satisfaction- Assess the contractor’s responsiveness to customer concerns and “user friendliness” in ROUTINE matters.

EX VG S MG US N/O

H. Customer Satisfaction- Assess the contractor’s responsiveness to customer concerns and “user friendliness” in UNEXPECTED DIFFICULTIES.

EX VG S MG US N/O

I. Repeat Business- Assess the likelihood that you would want this contractor to perform another contract for you in the near future.

EX VG S MG US N/O

J. List Contractor’s Weak Points:

K. List Contractor’s Strong Points:

L. List any other projects this contractor has completed for you:

Source Selection Information - See FAR 2.101 and 3.104

DVIRC

Attachment #2

PAST PERFORMANCE DATA

(Note: Offerors are not to change the spatial structure of this form, i.e. borders, block size, etc.)

1. Complete Name of Reference (Government agency, commercial firm, or other organization)

2. Complete Address of Reference

3. Contract Number or other control number

4. Date of contract

5. Date work was begun

6. Date work was completed

7. Contract type, initial contract price, estimated cost and fee, or target cost and profit or fee

8. Final amount invoiced or amount invoiced to date

9a. Reference/Technical point of contact (name, title, address, telephone no. and email address)

9b. Reference/Contracting point of contact (name, title, address, telephone no. and email address)

10. Location of work (country, state or province, county, city)

11. Current status of contract (choose one):

[ ] Ongoing [ ] Complete [ ] Terminated for Convenience [ ] Terminated for Default [ ] Other (explain)

12. Provide brief information describing the contract and the relevancy of the effort to be performed in accordance with the Performance Work Statement (PWS) and requirements of the solicitation. Provide an estimated % of relevancy of the referenced contract to the requirements set forth in this solicitation. Relevance shall address PWS work items. Relevance can be discussed in further detail on the attached summary description as set forth in block 14 below.

13a. Did this contract require a Small Business Subcontracting Plan pursuant to FAR 52.219-9? Yes ____, No_____.

13b. If “Yes” to 13a, have you regularly submitted SF 294/295 reports on time?

13c. Attach a copy of your most recently submitted SF 294/295.

14. Provide a summary description of the contract work, not to exceed one (1) additional page in length as an addendum to this cover page. Attachment 5 submission shall not exceed two (2) pages in total (1 cover page + 1 addendum page).

Describe the nature and scope of work, its relevancy to this contract, and a description of any problems encountered and your corrective actions. Attach the explanation to this form.

Source Selection Information - See FAR 2.101 and 3.104

DVIRC

Attachment L- 1 - Past and Present Performance Information