Past Performance Questionnaire- Attachement 1-20-12.doc

ATTACHMENT D (Phase I)

PAST PERFORMANCE QUESTIONNAIRE FOR CONTRACTOR REFRENCES

INSTRUCTIONS FOR COMPLETING THIS QUESTIONNAIRE

A representative of the client, for whom the contractor is currently performing work or has performed work in the past, shall complete all sections of this questionnaire. If the client receiving this questionnaire is a federal agency, then this questionnaire should be completed by the Contracting Officer’s Technical Representative (COTR).

The representative shall complete Sections B and C of the questionnaire by using the rating schedule found below and choosing the adjective that best describes the contractor’s work. Check the box that describes the appropriate rating. If a specific question does not pertain to the contract, please respond to the question by noting that it is not applicable (“N/A”). When possible, please provide a brief explanation for the ratings in the comment area.

The representative shall complete Section D by using the rating schedule found below or by simply checking the Yes or No bracket where appropriate. Please pay special attention to the question concerning the overall rating of the contractor. A brief explanation for rating in the comment area would be especially helpful.

Section E, including signature and date, provides essential contact information in the event that the Agency needs to clarify any comments provided.

The adjective rating scale for all sections is defined below:

Outstanding

The contractor’s past performance indicates a record of meeting client requirements with a high degree of success and high customer satisfaction.

Satisfactory

The contractor’s past performance indicates a record of meeting client requirements with a moderate degree of success and moderate customer satisfaction.

Unsatisfactory

The contractor’s past performance indicates a record of meeting client requirements with some degree of satisfaction and some degree of customer satisfaction.

PAST PERFORMANCE INFORMATION

A. CONTRACT INFORMATION

1. Name of the Contractor being evaluated

2. Is the Contractor a primary contractor or a subcontractor?

3. Contract number (if applicable): _______________________________________

4. Contract type (if applicable):

( ) Fixed Price ( ) CPAF

( ) Cost Reimbursement ( ) ID/IQ

( ) CPFF – Completion ( ) BOA

( ) CPFF – Term ( ) Labor Hour

( ) CPIF ( ) T & M

( ) Other: (Please specify) ________________________________________

5. Period of performance (include option years, if any):_______________________

6. Estimated annual contract amount or amount of annual services:_____________

7. Brief description of the contract services provided:

8. Was the contract a performance-based contract? ( ) Yes ( ) No

9. Did the contract include a ( ) Statement of Work, ( ) Performance Work Statement or a ( ) Statement of Objectives?

10. Type of award:

( ) Competitive

( ) Non-Competitive

( ) 8(a)

( ) Other

11. Name and phone number of COTR or primary contact at the client organization:

B. TECHNICAL PERFORMANCE

1. How effective was the Contractor in understanding the business requirements of your organization and integrating them with the technical requirements of the contract work?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

2. How technically qualified were the Contract personnel initially and throughout the contract?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

3. To what extent did the Contractor complete work and provide deliverables on time?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

4. To what extent were the contractor reports and technical documentation accurate and complete?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

5. To what extent did the Contractor identify and provide options for solving problems effectively and efficiently?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

6. To what extent did the Contractor use effective escalation procedures when problems arose?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

7. Given the Contractor’s options for solving problems, how successful was the Contractor in solving problems?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

8. To what extent did the Contractor conform to the requirements or satisfy the objectives of the contract?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

C. MANAGEMENT PERFORMANCE

1. To what extent was the Contractor able to recruit and maintain qualified and reliable personnel for the duration of the contract?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory Was recruitment timely? ( ) Yes ( ) No

Was turnover rate low? ( ) Yes ( ) No

Comment__________________________________________________________

2. To what extent was the Contractor able to manage the overall performance of the contract? Include consideration of such issues as planning, scheduling, monitoring, invoicing, and reporting.

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

3. To what extent was the Contractor effective in interfacing with your staff and other contractors and creating a successful team approach?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

4. To what extent did the Contractor coordinate, integrate, and provide for effective subcontractor management?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

D. CUSTOMER SATISFACTION

1. How would you rate the Contractor’s ability to demonstrate a cooperative, business-like attitude and respect for the interests of your agency or company?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment__________________________________________________________

2. Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, letters of direction, or other written notification of unsatisfactory performance or progress?

( ) Yes ( ) No

Comment__________________________________________________________

3. Have you ever terminated a contract with this Contractor on this or any other contract?

( ) Yes ( ) No

Comment__________________________________________________________

4. Were there any other problems on the contract in connection with this Contractor?

( ) Yes ( ) No

Comment_________________________________________________________

5. Given your comments on this questionnaire, how would you rate the over-all performance of the Contractor on this contract?

Rating: ( ) Outstanding ( ) Satisfactory ( ) Unsatisfactory

Comment_________________________________________________________

6. Would you recommend the Contractor for additional contracts?

( ) Yes ( ) No

Comment__________________________________________________________

7. Please use the following space to provide any additional information that you feel would be beneficial to PBGC in making its decision on the award of its contract to this Contractor.

Comment_________________________________________________________

E. CLIENT INFORMATION

The following information refers to the individual completing this questionnaire:

Name and Title (Printed)

Organization (Agency or Company)

Telephone Number

E-mail Address

Signature and Date

On or before the closing date, February, 20, 2012, the client shall send this questionnaire by e-mail to the Contracting Officer, Patrick McFarlane, mcfarlane.patrick@pbgc.gov, at the Pension Benefit Guaranty Corporation.

Please ensure that the Contracting Officer successfully receives this questionnaire by the identified date and time (Phase I evaluation).

Thank you for your time and attention in completing the questions in this evaluation.

Patrick McFarlane

Contracting Officer, Procurement Department Pension Benefit Guaranty Corp.

1200 K Street, N.W., Suite 1090

Washington, DC 20005

E-Mail: mcfarlane.patrick@pbgc.gov