PAST PERFORMANCE QUESTIONNAIRE.docx

ATTACHMENT TWO

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

The company who has provided you with this form is proposing on a Department of Homeland Security (DHS) solicitation to provide a full range of labor, supervision, tools, materials, parts, equipment, transportation, licenses, permits, certifications and management necessary to provide for equipment and system maintenance and repairs at government facilities in the Arizona Region to meet the mission needs of DHS. Past Performance is an extremely important part of the evaluation criteria for this acquisition, so your input is very important. The information is to be provided directly to, the DHS Contract Specialist. This information will not be disclosed to the offeror. Please provide an honest assessment and return the questionnaire to DHS, by e-mail, to the address shown below, no later than the time and date the solicitation closes _______________. If you have questions, please contact Dana L. Blake. Email address: Dana.L.Blake@cbp.dhs.gov.

Completed questionnaires should be emailed to the following address: Dana.L.Blake@cbp.dhs.gov.

GENERAL INFORMATION

1. OFFEROR’S NAME AND ADDRESS 2. CUSTOMER ORGANIZATION

3. CONTRACT NUMBER: 2a. EVALUATOR

4. CONTRACT VALUE: _______________________ NAME:

TITLE:

PHONE NO:

5. CONTRACT AWARD DATE: 6. CONTRACT COMPLETION DATE:

7. CONTRACT TYPE (Circle All That Apply): 8. COMPLEXITY OF WORK (Circle One Response):

Fixed Price Cost-Plus Fixed Price Cost-Plus Award Fee DIFFICULT ROUTINE

T & M OTHER

PART TWO: GENERAL INFORMATION CONTINUED

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

SOURCE SELECTION SENSITIVE INFORMATION

PART THREE: OFFEROR PERFORMANCE RATING

On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set of sub factors with four possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this offeror and indicate your assessment by placing an “X” under the appropriate heading. Offeror performance factors are:

Adjectival ratings are defined below and should be used as a reference in assessing performance:

C

(a) Performance of services?

(b) Delivery of reports or other documentation?

(c) Qualified Staffing

D

Did the contractor have an effective partnership with its team members?

What percentage of the contract award work was performed by the team members? (Provide Percentage)

GENERAL TOPICS

Did the contractor comply with 508 requirements?

(when applicable)

1. Has this contract been partially or completely terminated for default? YES NO

If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules - also include contract number, name, address, and phone number of Terminating Contracting Officer - TCO).

2. What was the contractor’s greatest strength in the performance of the contract?

3. What was the contractor’s greatest weakness in the performance of the contract?

4. Would you award another contract to this contractor? YES No

COMMENTS:

PART FOUR: EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF EVALUATOR

TITLE OF EVALUATOR DATE