Proposal Attachment 4 Past Performance Questionnaire.DOCX
DOCX document 25 KB Posted
- Attached to
- Level II Armed Security Guards / DR-4827-NC Federal contract opportunity
- Solicitation number
- 70FBR426R00000001
- Issued by
- Federal Emergency Management Agency
About this file
This document is a Past Performance Questionnaire template for federal contract reference checks, specifically designed for collecting detailed performance evaluations of contractors. The form is associated with a Federal Emergency Management Agency (FEMA) solicitation for Level II Armed Security Guards in North Carolina, and provides a structured method for previous clients to rate a contractor's performance across three key areas: Quality of Service, Timeliness of Delivery, and Overall Customer Satisfaction. The questionnaire allows references to provide adjectival ratings from Unsatisfactory to Excellent, with specific guidance for evaluating each performance dimension, and includes space for comments and recommendations about whether the contractor would be selected again for future work.
The form is intended to be completed confidentially and sent directly to the FEMA Contracting Officer, Meeka Tilahun, with contact information provided for submission via email. The ratings cover comprehensive aspects of contractor performance, including compliance with contract requirements, technical excellence, budget management, milestone achievement, delivery reliability, and overall responsiveness to contract needs. The document serves as a critical tool for evaluating a contractor's past performance, which is typically a significant factor in federal contract award decisions, particularly for service-based contracts like the referenced armed security guard services.
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Text version
Section J Attachment # Page 1of 2
Contract Performance Customer Questionnaire
1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information and will be sent directly to the Contract Specialist. This information is not to be released to the offeror. Completed questionnaires may be emailed to:
ATTN: Meeka Tilahun, Contracting Officer DHS/Federal Emergency Management Agency Phone: (202) 735-7274| Email: fmeeka.tilahun@fema.dhs.gov
2. Please complete:
Company/Contractor Requesting Reference
Agency/Company Name Providing Reference
Company/Contractor Name
Agency/Company Name
Point of Contact Name
Point of Contact Name
Phone #
POC E-mail / Phone #
E-mail address
Period of Performance
Fax Number
Supply/Service Provided
PAST PERFORMANCE RATING GUIDELINES
Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Poor, Fair, Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”
N/A - NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.
| Ratings |
| Quality of Service |
-Compliance w/contract requirements -Technical excellence -Within budget -Relationship of negotiated costs to actual Timeliness of Delivery -Met interim milestones -Reliable -Delivery Schedule achieved Overall Customer Satisfaction -Effective Management -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable/cooperative -Flexible -Pro-active
| Unsatisfactory |
| Nonconformances |
are comprising the achievement of contract requirements
| Delays are compromising achievement of contract requirements |
| Response is not effective |
| Poor |
| Nonconformances |
require major agency resources to ensure achievement of contract requirements
| Delays require major agency resources to ensure achievement of contract requirements |
| Response is marginally effective |
| Fair |
| Nonconformances require minor agency resources to ensure achievement of contract requirements |
| Delays require minor agency resources to ensure achievement of contract requirements |
| Response is somewhat effective |
| Good |
| Nonconformances |
do not impact achievement of contract requirements
| Delays do not impact achievement of contract requirements |
| Response is usually effective |
| Excellent |
| There are no quality problems |
| There are no delays |
| Response is effective |
PAST PERFORMANCE QUESTIONNAIRE
| 1. Company/Contractor Being Referenced: |
| 2. Solicitation/Contract Number: |
| 3. Address: | |
| 4. Contract Type: | |
| |_| | Firm Fixed Price |
| |_| | Cost Reimbursement |
| |_| | Other (Please Specify) |
| 5. Agency/Company Completing Reference: |
| 6. Agency/Company POC, Phone & Fax: |
7. Period of Performance:
8. Overall Contract Value: $
9. Title of Contract:
10. Description of Contract Service:
11. Complexity of Work: Difficult: |_| Routine: |_|
NOTE: Please use adjectival ratings from attached sheet.
| 12. Evaluation Factor |
| 13. Rating |
| 13. Comments (Attach additional sheets, if necessary.) |
a. Quality of Service
b. Timeliness of Delivery
c. Overall Customer Satisfaction
15. Would you select this company/contractor again? Please explain. (Attach additional sheet if necessary.)
16. Name & Date:
17. Title:
File details come from the government source that posted it. Updated .