Past Performance Questionnaire.docx
DOCX document 19 KB Posted
- Attached to
- B533--Potable Water Testing Federal contract opportunity
- Solicitation number
- 36C25926Q0620
About this file
This is a Past Performance Questionnaire template designed for evaluating contractor performance on federal contracts. The questionnaire requires contractors to provide comprehensive information about services performed, including detailed descriptions of objectives, scope of work, achievements, and challenges encountered. Respondents must supply performance dates, total contract value, organization addresses, contract and task order numbers, and primary point of contact information with current phone and email details.
The evaluation component uses a three-tier rating system: Outstanding (performance significantly exceeded expectations and accomplished unanticipated goals), Satisfactory (performance met expectations and contract requirements), and Unsatisfactory (performance did not meet expectations and requirements). Contractors rated other than Satisfactory must provide lengthy explanations with specific examples of strengths or areas for improvement. The questionnaire also requires the respondent to indicate whether the contractor was a prime contractor and to rate service complexity as High, Medium, or Low. All completed questionnaires must be signed and submitted to the contracting officer or designated point of contact by the quote deadline, with a verification statement affirming the accuracy and completeness of the information provided.
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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 .