Past Performance Questionnaire.docx

Past Performance Questionnaire RFQ# 36C259Q0031 Instructions:

1. Complete all sections of the questionnaire.

2. Ensure all contact information is accurate and up-to-date.

3. Have the contractor send a signed and completed questionnaire to the contracting officer or designated point of contact by the quote deadline.

1. Description of Services Performed:

Please provide a detailed description of the services performed under this contract. Include any specific objectives, scope of work, and notable achievements or challenges encountered.

Prime contractor? Yes or no Complexity (HIGHLIGHT OR CIRCLE ONE): HIGH MEDIUM LOW

2. Performance Dates:

Start Date (MM/DD/YYYY):

End Date (MM/DD/YYYY):

3. Total Contract Value:

Please provide the total value of the contract (in USD):

4. Company Being Reviewed:

Organization Name:

Street Address:

City:

State:

ZIP Code:

5. Contract Numbers:

Contract Number:

Task Order Number (if applicable):

6. Performance Rating:

· Please rate the overall performance of the contractor according to the following criteria:

· Outstanding: Performance significantly exceeded expectations in all essential areas and accomplished goals that were not anticipated.

· Satisfactory: Performance met expectations and contract requirements.

· Unsatisfactory: Performance did not meet expectations and contract requirements.

· Please check the appropriate rating:

· □ Outstanding

· □ Satisfactory

· □ Unsatisfactory

· Additional Comments (if rated other than satisfactory):

· Lengthy explanation or justification for the given rating, including examples of the contractor's strengths or areas for improvement:

Verification:

The information provided above is accurate and complete to the best of my knowledge. I authorize the verification of the services performed as described.

Signature:

Name:_________________________ Title:___________________________ Date:__________________________