Past_Perf_Questionnaire.pdf

RFQ#170004609

Mobile Tactical Operations Center (MTOC) Refurishment

Version 1.0 Page 1

PAST PERFORMANCE QUESTIONNAIRE

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past Performance Evaluation, Solicitation DJF-15-1200-Q-0000109

TO:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a MTOC Ref contract with the Federal Bureau of Investigation.

Your prompt attention to this questionnaire will be greatly appreciated. Once completed please email to Ms. Jerri Newton at Jerri.Newton@ic.fbi.gov.

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/af_afmc/far/Far02.doc#T2101 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/af_afmc/far/FAR03.DOC#b3104

PAST PERFORMANCE QUESTIONNAIRE

Solicitation: RFQ170004609

A. GENERAL INFORMATION: (for contractor you are providing past performance evaluation on)

Contractor’s Name: ____________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________*

Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION: (information of person filling out this questionnaire)

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: _____________________ _____________________________ Email Address: _____________________

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements.

The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

does not meet some contractual requirements.

The contractual performance of the element or sub-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.

does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

1. Provided experienced managers with the technical and administrative abilities needed to meet contract requirements.

2. Understood/complied with customer objectives and technical requirements.

3. Assigned personnel with the required skills to accomplish the work?

4. Provided effective quality control and/or inspection procedures to meet contract requirements.

5. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

6. Displayed initiative to solve problems.

7. Met established project schedules.

8. Demonstrated expertise with specialized Government communications equipment.

9. Insured vehicle and trailer modifications were in compliance with all local, state, and federal laws and regulations?

10. Provided a product that operated as expected and required little maintenance and/or repair.

11. Met forecasted costs and performed within contract costs

12. Provided timely resolution of warranty defects.

13. Cooperated with Government personnel after award.

14. How would you rate the contractor's overall performance?

15. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES/NO

16. Would you award another contract to this contractor? If not, explain in

“remarks.”

YES/NO

17. Is the contractor rated in CPARS? YES/NO

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

Remarks:_____________________________________________________________________________