Past Performance Questionnaire.docx

DOCX document 19 KB Posted

Attached to
Q301--36C259-26-AP-0419 | Prostate Cancer Testing Artificial Intelligence (AI)
Solicitation number
36C25926Q0700
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About this file

This is a Past Performance Questionnaire template designed to collect and evaluate contractor performance data for federal contracting purposes.

The questionnaire requires contractors to provide comprehensive information about services performed under a contract, including detailed descriptions of objectives, scope of work, and achievements or challenges. Respondents must supply standard contract details such as performance dates, total contract value, contract and task order numbers, organization addresses, and primary point of contact information. The questionnaire includes a performance rating scale with three levels: Outstanding (performance significantly exceeded expectations with unanticipated accomplishments), 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 and justifications with specific examples of strengths or areas for improvement. The completed questionnaire must be signed by an authorized representative and submitted to the contracting officer or designated point of contact by the quote deadline. All contact information must be accurate and current, and contractors must verify that all information provided is accurate and complete to the best of their knowledge.

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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 .