Past_Performance_Questionnaire.pdf

M:\GROUPS\OCC\SHAREDOC\TDAT SERVICES\Z-KATIE\MIDLAND, TX SOT\RFQ DOCS\A-BLANK

SOLICITATION-AWARD-ADMIN FILE\FLAP B\TAB 6 - SOLICITATION DOCUMENT\PAST PERFORMANCE

QUESTIONNAIRE.DOCX

PAST PERFORMANCE QUESTIONNAIRE

I. CONTRACT IDENTIFICATION

A. Contractor _______________________________

B. Contract Number _______________________________

C. Contract Type _______________________________

Competitive [ ] Yes [ ] No Follow-on [ ] Yes [ ] No

D. Period of Performance _________________________

E. Estimated Maximum Contract Total _________________________ (Including all option periods, i.e.

Indefinite Delivery, Indefinite Quantity Contract)

F. Estimated Contract Total ________________________ (Including all option periods, i.e. Requirements Contract)

G. Product Description __________________________________________ and/or services __________________________________________ provided __________________________________________

II. CLIENT IDENTIFICATION

A. Name of Government Activity _________________________________ (Include point of contract, _________________________________ phone number, fax number, _________________________________ and address) _________________________________

B. Name of Commercial Activity _________________________________ (Include point of contact, _________________________________ phone number, fax number, _________________________________ and address) _________________________________

C. Geographic Distribution of _________________________________ Services under this Contract (i.e., Local, Nationwide, Worldwide)

D. Number of Locations serviced _________________________________ by this contract

QUESTIONNAIRE.DOCX

Contractor: _____________________________ Client: _____________________________ Contract No: _____________________________

III. EVALUATION

A. PERFORMANCE HISTORY

1. To what extent was the Quality of Services provided by the Contractor?

Considerably surpassed minimum requirements..........{ }4 Exceeded minimum requirements........................{ }3 Met minimum requirements.............................{ }2 Less than minimum requirements.......................{ }1

2. To what extent did the contractor adhere to contract delivery and/or performance schedules?

Considerably surpassed minimum requirements..........{ }4 Exceeded minimum requirements........................{ }3 Met minimum requirements.............................{ }2 Less than minimum requirements.......................{ }1

3. To what extent were the contractor reports accurate and complete?

Considerably surpassed minimum requirements..........{ }4 Exceeded minimum requirements........................{ }3 Met minimum requirements.............................{ }2 Less than minimum requirements.......................{ }1

4. To what extent did the contractor foster good business relations?

Considerably successful..............................{ }4 Generally successful.................................{ }3 Little success.......................................{ }2 No success...........................................[ }1

QUESTIONNAIRE.DOCX

Contractor: _____________________________________ Client: _____________________________________ Contract No. _____________________________________

III. EVALUATION (continued)

A. PERFORMANCE HISTORY

5. To what extent did the contractor provide customer satisfaction?

Considerably successful..............................{ }4 Generally successful.................................{ }3 Little success.......................................{ }2 No success...........................................{ }1

6. If you had it to do over again would you select this contractor?

Yes __________ No __________ Not Sure __________

7. If you were in my position would you select the Contractor?

Yes __________ No __________ Not Sure __________

8. Can you provide the names of three other persons who can tell me about this contractor?

Name _____________________ Phone # _______________________

Name _____________________ Phone # _______________________

Name _____________________ Phone # _______________________