Performance Assessment Questionnaire.pdf

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BTD AUTOCLAVES AND GLASSWASHER PREVENTATIVE MAINTENANCE AND REPAIR
Solicitation number
W911S625QA005
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This is a Performance Assessment Questionnaire and cover letter from the US Army Mission and Installation Contracting Command at Dugway Proving Ground (MICC-DPG) for Request for Quote W911S6-25-Q-A005. The Army is conducting a competitive source selection for services related to NAICS code 811210 and requires past performance evaluations from previous clients of potential offerors. The questionnaire must be completed and returned to Contracting Specialist Jeremy MacDougall at jeremy.a.macdougall.civ@army.mil no later than 15 days after receipt or by August 28, 2025, whichever occurs first.

The questionnaire uses a four-tier confidence rating system (Substantial, Satisfactory, Limited, or No Confidence) to evaluate contractor performance across multiple criteria including compliance with specifications and workmanship standards, project management effectiveness, timeliness of deliverables, cost control for cost reimbursement contracts, and customer satisfaction. The form requires both the offeror and the reference contact to complete separate sections, with the offeror providing contract identification details and the reference providing detailed performance ratings with written rationale for each assessment area. The questionnaire also requests information about other relevant past performance contacts and allows for general comments about the contractor's performance.

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Solicitation - W911S625QA005.pdf PDF

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Performance Assessment Questionnaire – Cover Letter

DEPARTMENT OF THE ARMY

MISSION AND INSTALLATION CONTRACTING COMMAND

5330 VALDEZ CIRCLE MS#1, BUILDING 5330

DUGWAY, UT 84022-5001

28 July 2025

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal

(RFQ) W911S6-25-Q-A005

Dear Sir/Ma’am, The US Army Material and Installation Contract Command- Dugway Proving Ground (MICC-DPG) is currently conducting a competitive source selection to evaluate offerors on the subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state, or local government or commercial contracts as compared to the North American Industry Classification System [NAICS] 811210. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to the MICC-DPG, no later than 15 days after receipt of request or 28 August 2025, whichever occurs first. Submit your completed questionnaire to Jeremy MacDougall, jeremy.a.macdougall.civ@army.mil.

Your cooperation is greatly appreciated. Questions may be directed to the undersigned at (520)687-1478 or Jeremy.a.macdougall.civ@army.mil

Sincerely, Jeremy MacDougall Contracting Specialist

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 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)

A. CONTRACT IDENTIFICATION

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

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.

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: _________________________________________________________

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

Rationale: __________________________________________________________

C. Timeliness of Performance for Services and Product Deliverables.

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

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

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

Comments: _________________________________________________________

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

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: ______________________________________________

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

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

Thank you for your assistance.

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