S02 Past Performance Questionnaire.pdf
PDF 152 KB Posted
- Attached to
- Z2DA--523A4-CSI-401 Cath Lab Site Prep Federal contract opportunity
- Solicitation number
- 36C24125R0074
About this file
This document is a Past Performance Questionnaire template designed for federal contract performance evaluations. The form provides a structured format for capturing detailed contractor performance information across multiple evaluation factors, including quality of work, personnel, cost/budget control, customer satisfaction, timeliness of performance, business relations, and overall performance. The document includes comprehensive rating guidelines that allow evaluators to rate contractor performance on a scale from Unsatisfactory to Exceptional, with specific criteria defined for each rating level in different performance categories. The rating guidelines offer granular descriptions of what constitutes performance at each level, enabling a systematic and objective assessment of a contractor's past performance.
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Text version
FOR OFFICIAL USE ONLY
PAST PERFORMANCE QUESTIONNAIRE
1. Contractor Name:
Role on Project:
2. Contract Number:
3. Contractor Address: 4. Contract Type:
□ Firm Fixed Price
□ T&M/LH
□ Cost Reimbursement
□ Other (Please Specify):
5. Procuring Agency/Company Name: 6. Agency/Company POC:
Phone:
Email:
7. Period of Performance: 8. Dollar Amount of Award: $
Annual Amount: $
Total Dollar Value w/ Mods:$
9. Title of Contract:
10. Description of Contract Service/Scope of Contract:
11. Complexity of Work:
FOR OFFICIAL USE ONLY 2
NOTE: Please use adjectival ratings from attached sheet.
12. Evaluation Factor 13. Comments (Mandatory, Attach additional sheets, if necessary.) 14. Rating
a. Quality of Work
b. Personnel
c. Cost/Budget Control
d. Customer Satisfaction
e. Timeliness of Performance/Deliverables
f. Business Relations
g. Overall Performance
15. Would you hire this contractor again?
Why or Why Not?
16. Name:
Date:
17. Title:
FOR OFFICIAL USE ONLY 3
PAST PERFORMANCE RATING GUIDELINES
Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, and Exceptional. Use the following instructions as guidance in making these evaluations. Please use the comments area on the preceding form to justify the rating given.
Ratings Quality of Work/ Cost/Budget Customer Timeliness of Business
Personnel/Service Control Satisfaction Services/Deliverable Relations
Customer -Effective Mgmt.
-Compliance w/contract Satisfaction is a -Met interim -Business like requirements -Within budget measure of how milestones correspondence -Accuracy of reports -Current, accurate, products and -Reliable -Responsive to -Appropriateness of personnel complete billings -Relationship of services supplied by a company
-Responsive to technical direction contract requirements -Prompt notification
-Technical excellence negotiated costs to meet or surpass -Completed on time of problems actual
-Cost efficiencies customer expectations.
-Reasonable/ cooperative
-Change orders -Flexible issued -Pro-active
Unsatisfactory Nonconformances are comprising the achievement of contract requirements
Cost issues are comprising performance
1 - Very Unsatisfied
Delays are compromising achievement of contract requirements
Response is not effective
Marginal Nonconformances Cost issues require major agency resources to ensure achievement of contract requirements
2 - Somewhat Delays require major agency resources to ensure achievement of contract requirements
Response is require major agency Dissatisfied marginally effective resources to ensure achievement of contract requirements
Satisfactory Nonconformances do not impact achievement of contract requirements
Cost issues do not impact achievement of contract requirements
3 - Neither Satisfied Nor Dissatisfied
Delays do not impact achievement of contract requirements
Response is usually effective
Very Good There are no quality problems/issues, and the
There are no cost management issues
4- Somewhat Satisfied
There are no delays Response to inquiries and/or contractor has and the Contractor technical, service, substantially exceeded the contract performance has exceeded the contract administrative issues are effective.
requirements without requirements, commensurate additional achieving cost costs to the Government savings to the Government.
Exceptional The contractor has The contractor has 5 - Very Satisfied The contractor has The contractor has demonstrated an demonstrated an demonstrated an demonstrated an exceptional performance level that was exceptional performance. It is exceptional performance level.
exceptional performance level.
significantly in excess of expected that this It is expected that It is expected that anticipated achievements rating will be used in this rating will be this rating will be and is commendable as those rare used in those rare used in those rare an example for others. It circumstances circumstances circumstances is expected that this where the contractor where contractor where contractor rating will be used in achieved cost performance clearly performance clearly those rare circumstances savings and exceeds the exceeds the where contractor performance clearly performance levels performance levels performance clearly exceeds the performance exceeds the performance levels described as "Exceptional".
described as "Exceptional".
levels described as described as "Exceptional". "Exceptional".
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