R4 - Past Performance Questionnaire 061126.pdf

ATTACHMENT R4

OSIST

OC-2026-132216 / RFP 75F40126R00020

PAST PERFORMANCE QUESTIONNAIRE

Offeror Name:

Name of Reference:

Title/Role:

Email: Phone:

Agency/Company:

CONTRACT INFORMATION:

Contract #:

Total Contract Value ($):

Period of Performance:

Was the Offeror Prime or Sub?

Description of product/service provided:

RATING CATEGORIES:

RATING CODE PERFORMANCE LEVEL

Very Good VG Performance meets contractual requirements and exceeds several requirements. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Satisfactory S Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal M Performance does not meet some contractual requirements. The contractual performance of the element being assessed 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.

Unacceptable U Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

Not Applicable NA Unable to provide a score. Performance in this area not applicable to effort assessed.

Using the rating categories on page 1, check the appropriate box for each assessment element and provide supporting narrative.

(1) Cost/Price Control – Rate the contractor's ability to control cost and deliver at the agreed-to price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).

VG S M U NA

Supporting Narrative:

(2) Schedule Adherence – How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?

VG S M U NA

Supporting Narrative:

(3) Performance – Rate the contractor's ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.

VG S M U NA

Supporting Narrative:

(4) Quality – How well did the contractor adhere to the requirements of a Quality Assurance Plan or

Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?

VG S M U NA

Supporting Narrative:

(5) Business Relations – Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor's responsiveness to managing changes in providing replacement personnel.

VG S M U NA

ASSESSMENT ELEMENTS:

Supporting Narrative:

(6) Personnel Qualifications – Rate the contractor’s ability to staff and retain a highly-qualified team with the knowledge and experience required to successfully complete the project.

VG S M U NA

Supporting Narrative:

(7) What is your overall rating of the contractor’s performance?

VG S M U NA

Supporting Narrative:

(8) Please identify the contractor’s strengths.

(9) Please identify the contractor’s weaknesses.

(10) Given the choice, would you award to this contractor again? Why?

CERTIFICATION:

I certify that the ratings and comments reflected in this questionnaire were made by the undersigned and are accurate to the best of my knowledge.

Signature______________________________________ Date ________________