Attachment__6_Past_Performance_QuestionnaireFinal.pdf

RFQ-DC-15-00190 (eBuy RFQ 1063096)

ATTACHMENT 6: PAST PERFORMANCE QUESTIONNAIRE

S O U R C E S E L E C T I O N S E N S I T I V E I N F O R M A T I O N

Name of Contractor:

CONTRACT INFORMATION

Name of Contractor: Contract Number: Contract Title:

Contract Value:

Type of Contract: Period of Performance:

The ratings below are supplied by the contractor identified above, NOT the contractor who is submitting a quote.

Performance Elements

Totally

Deficient

Poor

Inadequate

Adequate

Good

Superior

1. Quality of Product or Service

2. Timeliness of

Performance

3. Effectiveness of

Management

4. Initiative in Meeting

Requirements

5. Response to Technical

Direction

6. Responsiveness to

Performance Problems

7. Compliance with Cost

Estimates

8. Customer Satisfaction

9. Overall Performance

10. Remarks on superior performance: (Provide data supporting this observation; you may continue on a separate sheet if needed.)

11. Remarks on unsatisfactory performance: (Provide data supporting this observation;

you may continue on separate sheet if needed.)

12. Please identify any corporate affiliations with the contractor.

13. Would you do business with this firm again?

14. Information provided by:

Name:

Title:

Mailing Address (Street and PO Box):

City, State, and Zip Code:

Telephone number:

Fax number:

E-mail Address:

Time of Call:

Date Information provided: