S02 Past Performance Questionnaire.docx

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Q301-- Molecular Thyroid Testing
Solicitation number
36C25926Q0430
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This is a Past Performance Questionnaire template designed to evaluate contractor performance on federal contracts. The questionnaire requires contractors to provide comprehensive documentation of services performed, including detailed descriptions of scope, objectives, and achievements, along with performance dates, total contract value, and organizational contact information. Contractors must identify whether they served as prime contractors and rate the complexity of work as high, medium, or low, then submit the completed and signed form to the contracting officer by the quote deadline.

The questionnaire assesses overall contractor performance using three rating categories: Outstanding (performance significantly exceeded expectations with unanticipated accomplishments), Satisfactory (performance met expectations and contract requirements), or Unsatisfactory (performance failed to meet expectations). Contractors rated other than Satisfactory must provide detailed explanations including specific examples of strengths or areas requiring improvement. The form requires verification signature, contractor name, title, and date, with instructions that all sections must be completed with accurate and current contact information to be considered for award evaluation.

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Past Performance Questionnaire Instructions:

1. Complete all sections of the questionnaire.

2. Ensure all contact information is accurate and up-to-date.

3. Have the contractor send a signed and completed questionnaire to the contracting officer or designated point of contact by the quote deadline.

1. Name of contractor being reviewed:

2. Description of Services Performed:

· Please provide a detailed description of the services performed under this contract. Include any specific objectives, scope of work, and notable achievements or challenges encountered.

· Prime contractor? Yes or no

· Complexity: ☐ HIGH ☐MEDIUM ☐LOW

3. Performance Dates:

· Start Date (MM/DD/YYYY):

· End Date (MM/DD/YYYY):

4. Total Contract Value:

· Please provide the total value of the contract (in USD):

5. Addresses:

Organization Name:

Street Address:

City:

State:

ZIP Code:

6. Contract Numbers:

· Contract Number:

· Task Order Number (if applicable):

7. Point of Contact Information:

· Name:

· Title:

· Phone Number:

· Email Address:

8. Performance Rating:

· Please rate the overall performance of the contractor according to the following criteria:

· Outstanding: Performance significantly exceeded expectations in all essential areas and accomplished goals that were not anticipated.

· Satisfactory: Performance met expectations and contract requirements.

· Unsatisfactory: Performance did not meet expectations and contract requirements.

· Please check the appropriate rating:

· ☐ Outstanding

· ☐ Satisfactory

· ☐ Unsatisfactory

· Additional Comments (if rated other than satisfactory): Lengthy explanation or justification for the given rating, including examples of the contractor's strengths or areas for improvement:

Verification:

· The information provided above is accurate and complete to the best of my knowledge. I authorize the verification of the services performed as described.

Signature: Please sign as indicated below Name:_________________________ Title:___________________________ Date:__________________________

File details come from the government source that posted it. Updated .