Attachment_4_PAST_PERFORMANCE_QUESTIONNAIRE.pdf

ATTACHMENT 4

PBGC PAST PERFORMANCE QUESTIONNAIRE

PART I – CONTRACT IDENTIFICATION

Request offeror complete Part I prior to providing the Questionnaire to the customer point of contact for completion of Part II.

1. Prime Contractor Name: ______________________________________________________

2. Contractor’s Cage Code: ______________________________________________________

3. Contract Number: ____________________________________________________________

4. Contract Type (i.e., FP, T&M, LH, CR, etc.): ______________________________________

5. Description of Supplies or Services Provided: _____________________________________

6. Place of Performance: ________________________________________________________

7. Period of Performance: _______________________________________________________

8. Customer Name: __________________________________________________________

9. Customer Type (e.g., Federal, State, Local, or Commercial): _________________________

10. Request you indicate whether or not a Contractor Performance Assessment Report (CPAR)

(or more than one CPAR) has been completed for this contract by placing an “X” in the corresponding block. If “Yes” is selected, request you identify the periods covered by the

CPARs.

No Yes

Periods covered by CPARs: ______________________________________________________

PART II – CUSTOMER ASSESSMENT

Request customer point of contact complete Part II.

1. Point of Contact Name: _______________________________________________________

2. Point of Contact Title: ________________________________________________________

3. Point of Contact Organization: __________________________________________________

4. Point of Contact Phone: _______________________________________________________

5. Point of Contact E-Mail: ______________________________________________________

6. Years Worked with Subject Contract: ____________________________________________

Adjectival Ratings for Customer Assessment of Contractor’s Performance

CODE PERFORMANCE LEVEL

E EXCEPTIONAL – The contractor’s performance meets contractual requirements and exceeds many to the customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG VERY GOOD – The contractor’s performance meets contractual requirements and exceeds some to the customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or was satisfactory.

M MARGINAL – The contractor’s performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions, or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – The contractor’s performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems for which the contractor’s corrective actions appear or were ineffective.

N/A NOT APPLICABLE – Unable to provide a rating or item is not applicable to the subject contract.

Customer Assessment of Contractor’s Performance

Request you provide your assessment of the contractor’s performance in each of the areas identified below by placing an “X” in the corresponding block. Request a brief written explanation be included to support assessments of “E” (Exceptional), “M” (Marginal), or “U”

(Unsatisfactory).

1. Technical (Quality of supply or service) E VG S M U N/A

Ability of contractor to: provide accurate deliverables/reports; meet requirements of the contract;

provide timely proposals; respond to short notice requirements; and provide and adhere to quality control/ management plan.

Explanation: __________________________________________________________________

2. Cost Control (Not applicable to a fixed-price contract) E VG S M U N/A

Ability of contractor to: provide accurate contract cost estimates; track and control costs; meet and perform within negotiated costs; provide current, accurate, and complete invoices, and submit cost reporting information in a timely manner.

3. Schedule/Timeliness E VG S M U N/A

Ability of contractor to: deliver supplies or provide services in accordance with contract requirements; advise customer of potential delays in satisfying contract schedules and timelines; and develop solutions to maintain critical delivery schedules and timelines.

4. Management or Business Relations E VG S M U N/A

Ability of contractor to: maintain effective relationship between key contractor personnel and key Government personnel; manage, resolve problems and respond to and/or integrate changes in mission-related requirements.

5. Small Business Subcontracting (Not applicable to a small large business contract or a large business contact without a subcontracting plan).

E VG S M U N/A

Ability of contractor to: locate small business concerns to provide required supplies or services; establish subcontracting arrangements with small business concerns; and achieve small business subcontracting goals contained in subcontracting plan.

6. Customer Service E VG S M U N/A

Ability of contractor to: work cooperatively with customers; recognize customer needs; proactively identify potential problems; and identify solutions which satisfy contract requirements.

7. Management of Personnel (Not applicable to supply contracts).

E VG S M U N/A

Ability of contractor to: attract, recruit, hire, train, and retain qualified management and technical personnel to accomplish mission requirements; manage subcontractors to include identification and resolution of subcontractor problems; ensure continuation of service.

Additional Information

1. Request you indicate whether or not the contract was partially or completely terminated, or is pending termination by placing an “X” in the corresponding blocks. Request you place an “X” in each block that applies, and provide a brief written explanation if termination has occurred or is pending.

No Yes Default/Cause Convenience Pending Termination

2. Request you indicate whether or not you would have any reservations about having this contractor perform again on one of your critical and demanding programs by placing an “X” in the corresponding block. Request you provide a brief written explanation if “Yes” is selected.

No Yes

[Provide customer point of contact’s signature] [Enter date]

Name of customer point of contact Date

Upon completion and signature, request the customer point of contract e-mail or mail this PBGC

Past Performance Questionnaire directly to the PBGC contracting officer identified below.

Patrick McFarlane, Contracting Officer

McFarlane.Patrick@pbgc.gov

Mailing Address

PBGC Procurement Department

1225 I Street NW

Suite 330

Washington, D.C. 20005

Department Fax # (202)326-4162

Thank-you for taking the time to provide this past performance information.

mailto:McFarlane.Patrick@pbgc.gov