Past Performance Questionnaire.docx
DOCX document 19 KB Posted
- Attached to
- B533--Potable Water Testing
- Solicitation number
- 36C25926Q0419
About this file
This is a Past Performance Questionnaire template designed to collect contractor performance information for evaluation purposes in federal contracting. The questionnaire requires contractors to provide comprehensive documentation of services performed, including detailed descriptions of objectives, scope of work, and any notable achievements or challenges. Contractors must complete all sections with accurate contact information and submit the signed questionnaire to the contracting officer or designated point of contact by the quote deadline.
The questionnaire requests specific contract details including performance dates, total contract value, contractor name and address, contract and task order numbers, and point of contact information. Contractors must self-rate their overall performance using three categories: Outstanding (performance significantly exceeded expectations), Satisfactory (performance met expectations and requirements), or Unsatisfactory (performance failed to meet expectations). The template also includes a complexity rating scale (High, Medium, Low) and requires contractors to identify whether they served as the prime contractor. For any rating other than Satisfactory, contractors must provide lengthy explanations with examples of strengths or areas for improvement. The questionnaire concludes with a verification statement requiring the contractor's signature, name, title, and date to certify accuracy and authorize service verification.
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Text version
Past Performance Questionnaire 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. Name of contractor being reviewed:
2. 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: ☐ HIGH ☐MEDIUM ☐LOW
3. Performance Dates:
· Start Date (MM/DD/YYYY):
· End Date (MM/DD/YYYY):
4. Total Contract Value:
· Please provide the total value of the contract (in USD):
5. Addresses:
Organization Name:
Street Address:
City:
State:
ZIP Code:
6. Contract Numbers:
· Contract Number:
· Task Order Number (if applicable):
7. Point of Contact Information:
· Name:
· Title:
· Phone Number:
· Email Address:
8. 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: Please sign as indicated below Name:_________________________ Title:___________________________ Date:__________________________
File details come from the government source that posted it. Updated .