Past Performance - Questionnaire.pdf

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

(WHEN COMPLETED) SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 1

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program Manager):_____________________________________________________________________________________________ Agency or Business:

Address:

Telephone No. _______________________________ FAX No. ____________________________________

Return your completed questionnaire either electronically:

Lisa Harris Contract Specialist

Email: Lisa.Harris4@va.gov

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE

RELEASED TO THE OFFEROR.

PART I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________ CAGE Code: __________

Program Title and Brief Description:

Role in the Program/Work Performed As: _____Prime _____Subcontractor _____Vendor/Supplier

Contract Number: ________________________________ Number of Years?: Basic:________ Option: _________

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, etc._________________________________________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

Period of Performance:

1. Original Schedule (assuming all options exercised): Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised): Beginning Date _________ through ____________

3. Reason for difference (if applicable)___________________________________________________________________________

Contract Dollar Value:

1. Original MAX Contract $ Value (assuming all options are exercised: _________________________________________

2. Current MAX $ Value (assuming all options exercised): ____________________________________________________

3. Primary Causes of Changes: ___________________________________________________________________________

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 2

NOTE: In Part III, should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 3.

PART III.PERFORMANCE ASSESSMENTS.

Please check the appropriate rating for each of the following questions (see definitions on page 4):

U= Unknown Confidence NC= No Confidence LC=Limited Confidence SC= Satisfactory Confidence SU C= Substantial Confidence

U NC LC SC SUC

1. Extent to which Company’s products and/or services met the specification /performance requirements:

2. Configuration Management (first product delivered same as last):

3. Quality of Completed Product:

4. Overall management of subcontracting efforts:

5. Quality of Technical Manuals or Commercial Manuals:

6. Customer’s Satisfaction with warranty response times and corrective actions:

7. Adequate Number of Dedicated Resources For Your Program:

8. Timely recognition and notification of administrative, engineering, production, problems affecting the program:

9. Company performed independently without significant customer direction/oversight?

10. Monitoring of Program Schedules and Critical Milestones:

11. Completed Work on Time:

12. Company demonstrated positive responsiveness to unscheduled requirements or contract changes:

13. Ability of Company to contain cost or price performance in terms of initial reasonableness, actual experience or control of exigencies.

14. Satisfaction with implementation plan and achievement of steady state operations after contract award.

15. Identification of risk areas and addressing problems with solutions

16. Collection and tracking of performance information

17. Establishment of quality program

18. Demonstrated managerial and technical capability to perform requirements

19. Identification of improvements that enhance mission accomplishments

20. Overall Confidence

21. Has action been initiated to cancel or terminate the contract for default? If yes, explain.

22. Have there been any disputes/claims relative to the contract? If yes, explain.

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 3

23. Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract.

24. If given a choice, would you award to this contractor again? If not, please explain.

25. Do you feel you “got what you paid for” ? Please explain.

26. Additional Remarks.

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 4

ASSESSMENT RATING SYSTEM

Please do not include this page when returning the completed questionnaire.

Performance Confidence Assessments Rating Description Substantial Confidence Based on the offeror’s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.

Satisfactory Confidence Based on the offeror’s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort.

Limited Confidence Based on the offeror’s recent/relevant performance record, the Government has a low expectation that the offeror will successfully perform the required effort.

No Confidence Based on the offeror’s recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.

Unknown Confidence (Neutral) No recent/relevant performance record is available or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

NOTICE TO QUESTIONNAIRE RESPONDENTS: Please do not include this page when returning the completed questionnaire.