Past Performance Evaluation Questionnaire 36C24226Q0290.docx

?.## PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Offeror Name: ______________________Solicitation Number: _36C24226Q0290__

PART I: BACKGROUND INFORMATION (To be completed by offeror)

Customer/Client Name/Address: _________________________________________________________

Agency Point of Contact: _________________________________________________________

Telephone Number: _________________________________________________________

Cell Phone Number: _________________________________________________________

Email: _________________________________________________________

Contract Number: _________________________________________________________

Place of Performance: _________________________________________________________

Period of Contract: _________________________________________________________

Contract Type: _________________________________________________________

Facility Type: _________________________________________________________

Gross Square Footage in Building: _________________________________________________________

Contract Value: _________________________________________________________

Description of Services Performed:

PART II. PAST PERFORMANCE EVALUATION (To be completed by entity receiving services)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in awarding a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and or explanations (use additional pages if necessary).

RATING SCALE: Use the following adjectival ratings to answer the questions.

Outstanding (O) – Performance met contractual requirements and exceeded many requirements that benefited the end user. Work was accomplished with few, if any minor problems for which corrective actions taken by the contractor were highly effective.

Good (G) – Performance met contractual requirements and exceeded some requirements that benefited the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable (A) – Performance met contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal (M) – Performance did not meet some contractual requirements; serious problems with contractor performance were experienced for which contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable (U) – Performance did not meet most contractual requirements; serious problems with contractor performance were experienced for which corrective actions were ineffective.

N/A - Not applicable because it was not a requirement, never an issue, or there is no knowledge of the item in question.

NOTE: For statements indicating “Outstanding” “Marginal” or “Unsatisfactory” please provide an explanation in the comments section of the survey.

CONTRACTOR PERFORMANCE EVALUATION SURVEY

A. QUALITY OF SERVICE:

(1) The contractor is both ISO 9001:2015 and ISO 13485 certified.

(2) Contractor works in accordance with ANSI-AAMI ST-79 standards.

(4) The contractor performs regularly scheduled maintenance without assistance.

B. RECRUITMENT/ RETENTION:

The contractor demonstrated the ability to actively and successfully recruit qualified personnel.

C. TIMELINESS/ SCHEDULE:

(1) Contractor performed services according to schedule.

(2) Contractor responded to unscheduled services according to established response times.

(3) Contractor invoiced timely.

D. BUSINESS RELATIONSHIPS:

(1) Contractor demonstrated an overall effective management effort.

(2) Contractor maintained an open line of communication so that the Contracting Officer’s Representative (COR) or Contracting Officer was apprised of technical, cost, and schedule issues.

(3) Contractor presented information and correspondence in a clear, concise, and business-like manner.

(4) Contractor promptly notified the COR and/or Contracting Officer in a timely manner regarding urgent issues.

E. CUSTOMER SATISFACTION:

(1) The services provided adequately met the needs of the contract.

(2) The Contractor was able to perform with minimal or no direction from the COR.

F. OVERALL CONTRACT PERFORMANCE:

Considering all areas of this survey, how would you rate the contractor for their overall contract performance?

OTHER:

(1) Would you award this firm another contract? ( ) Yes ( ) No If you answered “No” provide an explanation:

(2) Was the contract terminated for default? ( ) Yes ( ) No If you answered “Yes”, provide an explanation:

(3) Has the Contractor received a cure notice, show cause notice, ( ) Yes ( ) No suspension of progress payments, etc.?

If you answered “Yes”, provide an explanation:

COMMENTS: (Required for ALL Outstanding, Marginal and Unsatisfactory Ratings) (End of Past Performance Evaluation Questionnaire)

Name:________________________ Title: _________________________ signature: ______________________