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 for contractors to document and justify their performance on federal contracts. The questionnaire requires contractors to provide comprehensive information about services performed, including detailed descriptions of objectives, scope of work, and achievements or challenges. Key sections include contractor identification, performance dates, total contract value, organizational addresses, contract and task order numbers, and designated points of contact with complete contact information.

The questionnaire uses a standardized three-tier performance 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 contract requirements). Contractors rated other than Satisfactory must provide lengthy explanations with examples of strengths or areas for improvement. The questionnaire also requires contractors to indicate whether they served as the prime contractor and to classify the complexity of work as High, Medium, or Low. Completed and signed questionnaires must be submitted to the contracting officer or designated point of contact by the quote deadline, with all information certified as accurate and complete by the contractor's authorized representative.

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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 .