Past Performance Questionaire ID04200073 08 13 2020.doc

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Benefits Methods Development and Other Relevant Analyses for the Evaluation of Air Pollution Control Policies
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ID04200073
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FOR OFFICIAL USE ONLY

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

ATTACHMENT

Return Your Completed Questionnaire via Email directly to joshua.adams@gsa.gov NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND WILL NOT BE RELEASED TO THE OFFEROR.

1. Please provide the following information about you and your company:

Name of Respondent
Name:

Role Relative to Contract (Buyer, Program Manager, etc.)

Role:

Agency or Business:
FORMTEXT
Address:
FORMTEXT
Telephone No.:
FORMTEXT

Email Address:

Fax Number:
FORMTEXT

2. Please provide the following information on the specific program:

Contractor/Business:
FORMTEXT

Cage Code:

Program Title and Brief Description:

Contractor’s Role in the Program:
Prime FORMCHECKBOX

Subcontractor FORMCHECKBOX

Vendor/Supplier FORMCHECKBOX

Contract/Task Order Number:
FORMTEXT
Number of Years:
Basic:

Option:

Contract Type (i.e. FFP, T&M, Cost-Reimbursable)
FORMTEXT
Competitively Awarded Contract:
Yes

No:

3. General Information about this Contract

Period of Performance of Contract or Effort
Beginning Date FORMTEXT

Through FORMTEXT

Have there been any changes to the original schedule? If yes, please explain.

FORMTEXT

Original Contract Dollar Value
FORMTEXT

Current Contract Dollar Value

If a dollar value difference exists, please explain that difference here or if difference was attributed to a cost overrun, the information can be provided in question 5 below.

4. Evaluation

Please mark the appropriate rating for each criterion using the standards provided below:

Note: Should your responses be other than “High Confidence”, please provide supporting documentation in the “Additional Remarks” section below or on additional sheets if necessary. If supporting documentation is not provided for ratings that are other than “High Confidence”, the ratings will be considered to be unsubstantiated and will be interpreted as “High Confidence”.

Criteria
HC
MC
LC
N/O

1. Quality of Services – Compliance with contract requirements, technical excellence, accuracy of reports, etc.

2. Management Controls – Responsiveness, management of staff, project management, etc.

3. Cost Control – Management of the contract/task budget and cost control processes.

4. Schedule Compliance – Timeliness compared to the schedule of activities, milestones, and/or deliverables.

5. Customer Satisfaction - Reasonable and cooperative behavior and commitment to customer service.

6. Overall Performance Assessment

HC
=
High Confidence
The Contractor’s demonstrated performance in this criterion leaves virtually no doubt that the Contractor successfully performed the required effort.
MC
=
Medium Confidence
The Contractor’s demonstrated performance in this criterion leaves some doubt that the Contractor successfully performed the required effort.
LC
=
Low Confidence
The Contractor’s demonstrated performance in this criterion leaves substantial doubt that the Contractor successfully performed the required effort.
N/O
=
Not Observed
The Contractor’s demonstrated performance in this criterion was not observed by the evaluator.

5. Miscellaneous Questions If the previous effort was Cost or T&M did the contractor assist the Government in any way to move the contract type to a less risky contract type?

Has action been initiated to cancel or terminate the contract for default? If yes, explain.

FORMTEXT

Have there been any disputes/claims relative to the contract? If yes, explain.

FORMTEXT

Describe the contractor’s or offeror’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract.

FORMTEXT

If given a choice, would you award to this contractor again? If not, please explain.

FORMTEXT

Do you feel you “got what you paid for”? Please explain.

FORMTEXT

Additional Remarks. FORMTEXT

PAGE

SOURCE SELECTION INFORMATION – SEE FAR 3.104

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