Performance Assessment Questionnaire.pdf

Performance Assessment Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does [and/or notify the Contracting Officer].

Please return the completed Questionnaire to the Contracting Officer identified in the cover letter within the stated timeframe.

Rating Definitions

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The Offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The Offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The Offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements.

Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The Offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror)

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: Rationale is required for each response.

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale:

A. CONTRACT IDENTIFICATION

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

A. Compliance of Products, Services, Documents, and Related Deliverables to Performance Requirements and Standards

B. Effectiveness of Contract Management (to include use and control of subcontractors).

C. Timeliness of Performance for Services and Deliverables.

D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name):

Telephone Number:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter.

Thank you for your assistance.

E. General Comments. Provide any other relevant performance information.

G. Respondent Identification. Please provide the following information:

F. Other Information Sources. Please provide the following information: