SA04 - FSLT - Past Performance Questionaire.pdf

N3220524R4004

SOURCE SELECTION INFORMATION — SEE FAR 2.101 & 3.104

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

ONLY FOR CONTRACTS NOT IN CPARS

TO:

PHONE: EMAIL:

INFORMATION REQUEST

Military Sealift Command (MSC) is currently in the process of soliciting offers for a contract.

____________________ has provided your name and organization as a reference regarding their record of past performance under Contract No. ___________________. Specifically, we are looking for performance information in the following areas:

a.) Quality of Product or Service b.) Timeliness or Scheduling of Service/Deliveries c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing (Including Subcontractors)

In order for our team to compile its evaluation, we request that you complete the attached questionnaire and email it, and any other pertinent information, by 5:00pm Eastern Time on XXXX 2024 to Mr. John Walker via email at john.m.walker154.civ@us.navy.mil AND Mr. Lawren Wolf via e-mail at Lawren.h.wolf.civ@us.navy.mil Any relevant information you have would be vital in our assessment of the aforementioned Contractor.

Thank you, John Walker

From: (Name and Address of Organization) __________________________________________________

(Point of Contact Name) __________________________________________________

(Phone Number) __________________________________________________

(E-mail Address) __________________________________________________

To (Point of Contact Name) John Walker

(E-mail Address) john.m.walker154.civ@us.navy.mil jordan.castellat1 Highlight

CONTRACTOR PERFORMANCE QUESTIONNAIRE

CONTRACTOR NAME: CONTRACT NUMBER:

☐ Prime ☐ Sub-Contractor EVALUATION PERIOD: DELIVERY/TASK ORDER NO. (if applicable):

1. Please describe the service/supply provided by the Contractor for your organization.

2. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional, Very Good, Satisfactory, Marginal, or Unsatisfactory. See next page for definition of ratings. For ratings of “Exceptional” or “Unsatisfactory,” please provide a brief explanation.

EXCEPTIONAL VERY GOOD SATISFACTORY MARGINAL UNSATISFACTORY

OVERALL PERFORMANCE RATING

Please provide an overall rating of the Contractor’s performance for the referenced contract/delivery order.

a.) Quality of Product or Service:

Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence b.) Timeliness or Scheduling of Supplies/Deliveries: Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction: Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business subcontracting program and satisfaction with Contractor’s service.

d.) Key Personnel and Staffing (Including Subcontractors): Qualified personnel, effective performance and conduct.

3. Would you hire this Contractor to provide supplies/services for your organization in the future? Yes No Please provide comments using additional pages if desired.

Signed:__________________________________

DEFINITION OF RATINGS FOR PAST PERFORMANCE

Exceptional Performance meets/met contractual requirements and exceeds/exceeded many to the customer’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets/met contractual requirements and exceeds/exceeded some to the Customer’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance meets/met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear to be or were satisfactory.

Marginal Performance does not/did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet or did not identify corrective actions.

Unsatisfactory Performance does not/did not meet most contractual requirements and if currently being performed, recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor's corrective actions appear or were ineffective.