Past_Performance_Questionnaire.pdf

N32253-25-Q-0010

PAST PERFORMANCE QUESTIONNAIRE

Instructions to Offeror

The Offeror shall complete Section A of the Questionnaire. Separately, the Offeror shall provide the entire Past

Performance Questionnaire, with Section A completed, to the evaluator for him/her to complete Parts B and C. The

Offeror shall provide a copy of the email sent to the evaluator with the proposal submittal. Completed questionnaires shall be forwarded directly from the evaluator to the Government point of contact listed in questionnaire.

NOTE: ONCE COMPLETED BY THE EVALUATOR, QUESTIONNAIRES MUST BE DIRECTLY

TRANSMITTED TO THE GOVERNMENT AS DESCRIBED ON THE FOLLOWING PAGE. COMPLETED

QUESTIONNAIRES RECEIVED FROM OFFERORS ARE NOT ACCEPTABLE.

Instructions to Evaluator

Pearl Harbor Naval Shipyard and Intermediate Maintenance Facility Code 410 - Contracts Division Code is requesting an evaluation of an Offeror’s past performance for source selection purposes. Accordingly, request your candid assessment of the Offeror’s past performance; please see Section A below for the identity of the Offeror and contract of interest.

Once completed, this questionnaire and any appended information becomes Source Selection Sensitive and must be protected from disclosure. Access to this information shall be limited to Government procurement officials.

Hand-written evaluations are acceptable. Please answer each question in SECTION B by circling one of the ratings:

E V S M U N/A, where:

E-Exceptional; V-Very Good; S-Satisfactory;

M-Marginal; U-Unsatisfactory; N/A-Not Applicable

Exceptional (E) - Contractor performance substantially exceeded expected levels of performance.

Very Good (V) - Contractor performance exceeded expected levels.

Satisfactory (S) – Performance met expected levels.

Marginal (M) - Performance was less than expected.

Unsatisfactory (U) - Performance was significantly less than expected.

In addition, please provide supporting comments for each rating. Please use your supporting comments to highlight the Offeror’s specific strengths and weaknesses. You may use additional sheets if required. Your ratings and comments should reflect only “contractor liable” performance. You may supplement your knowledge with the knowledge and judgment of others in your organization.

Please enter the requested information in SECTION C for the person primarily responsible for completing the questionnaire, then transmit the completed questionnaire to the point of contact identified below. Thank you for your assistance in this matter.

Please forward the completed questionnaire no later than 300 PM HST on 6 Jan 2025 to kelliann.a.shimote.civ@us.navy.mil and lyndon.g.paloma.civ@us.navy.mil. Please do not provide completed questionnaires to the offeror.

mailto:kelliann.a.shimote.civ@us.navy.mil mailto:lyndon.g.paloma.civ@us.navy.mil.

SECTION A (To Be Completed by the Offeror)

1. Name of Offeror/Contractor:

Address of Offeror/Contractor:

2A. Contract Number (between Prime and Sub):

Task or Order No., where applicable:

2B. Contract Number (between Government and Prime):

Task or Order No., where applicable:

3A. Period of Performance:

3B. Place of Performance:

4. Detailed Description of Work/Scope of Effort:

5. Detailed Explanation Demonstrating Similarity to current Solicitation:

6. POC Name:

Address:

Tel. No.:

Voice:

Facsimile:

7. Method and Date Questionnaire Sent to POC:

Date:

Method:

SECTION B (To Be Completed by Evaluator)

E Exceptional; V-Very Good; S-Satisfactory;

M Marginal; U Unsatisfactory; N/A Not Applicable

1. Overall Contract Outcome: E V S M U N/A

Ability to satisfactorily complete all tasks while conforming to customer requirements, standards of good workmanship and safe practices.

Comments:

2. Schedule Performance: E V S M U N/A

Ability to develop accurate work schedules and adhere to those schedules, as well as the ability to adapt to changes in requirements and work schedules.

3. Technical Performance (Quality of Product): E V S M U N/A

Ability to overcome technical challenges by applying sound engineering principles, complete required engineering analyses and develop adequate technical reports and plans.

SECTION C (To Be Completed by Evaluator)

1. Name of Evaluator:

2. Position Title:

3. Administrating Authority/Agency:

4. Telephone Number: Voice

Facsimile

5. Signature: Date: