Section J_ATTACHMENT_G_Past Performance Survey.xls
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- SAQMMA09R0277
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Section J Attachment G Past Performance Survey
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Past Performance Survey
| ATTACHMENT G - PAST PERFORMANCE SURVEY | ||
| Introduction: The United States Department of State (DoS) is currently conducting a competitive procurement for [Insert Title of Program] support services, for which the prospective offeror [Insert Name of the Company] has been requested to identify Government agencies with whom it is currently or has been recently under contract, to serve as potential references on its past performance record. You are being asked to complete the attached Contractor Past Performance Survey. You may also be contacted by a DoS procurement official to arrange a telephone interview, using the survey as the focal point of the interview. To ensure frank and open evaluations and expressions of opinions by evaluators, all parties are advised that the identity of respondents completing the survey will be held in confidence and will not be released or disclosed to the contractor or outside the Government. | ||
| Instructions: Please complete all areas of this form indicated in light yellow. | ||
| PART I - CONTRACT INFORMATION | ||
| a. Contractor: | ||
| b. Customer Name (Federal Agency or Other): | ||
| c. Technical Point of Contact Information | ||
| i. Name: | ||
| ii. Telephone Number: | ||
| iii. Facsimile Number: | ||
| iv. E-mail Address: | ||
| v. Mailing Address: | ||
| vi. Position Title/Grade: | ||
| d. Contract Number: | ||
| e. Type of Contract | (Select responses from drop down menu) | |
| i. Negotiated or Sealed Bidding: | ||
| ii. Competitive or Non-Competitive: | ||
| iii. Firm-Fixed-Price, Cost-Plus-Fixed-Fee, Time-and-Materials, Labor Hour, or Other: | ||
| iv. Indefinite Quantity or Requirements: | ||
| f. Contract Period of Performance: | ||
| h. Initial Contract Value: $ | ||
| i. Current (or Completed) Contract Value: $ | ||
| j. Brief Description of the Contract Requirement: | ||
| PART II - GOVERNMENT PAST PERFORMANCE EVALUATION | ||
| EVALUATION CRITERIA | ||
| EXCEPTIONAL: Indicates the Contractor's performance within the area of evaluation clearly and consistently exceed contractual requirements. | ||
| ACCEPTABLE: Indicates the Contractor's performance within the area of evaluation met the contractual requirements. | ||
| MARGINAL: Indicates the Contractor's performance within the area of evaluation experienced minor problems for which solutions were satisfactory. | ||
| UNACCEPTABLE: Indicates the Contractor's performance within the area of evaluation experienced serious problems. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur. | ||
| EVALUATION AREA 1: TECHNICAL SERVICES | ||
| (Select the rating that applies from drop down menu) | ||
| Overall ability to promote an environment with highly rated customer service: | ||
| Overall ability to leverage and integrate technology in support of contract goals and objectives: | ||
| Overall ability to maintain information confidentiality and integrity across all services performed: | ||
| Track record in protecting information and information technology resources from security threats, malfeasance, and fraudulent use: | ||
| Overall effectiveness in program, risk, quality, performance management capabilities: | ||
| EVALUATION AREA 2: QUALITY OF SERVICES | ||
| (Select the rating that applies from drop down menu) | ||
| Overall ability to pro-actively and aggressively perform contract requirements: | ||
| Effectiveness of the contractor's training program and performance skills: | ||
| Ability to retain qualified personnel on the project: | ||
| Timeliness in filling open positions: | ||
| Effectiveness and reliability of contractor's key personnel: | ||
| EVALUATION AREA 3: TIMELINESS OF PERFORMANCE | ||
| (Select the rating that applies from drop down menu) | ||
| Overall performance in planning, scheduling, and monitoring: | ||
| Completion of major milestones on schedule: | ||
| Timely completion of efforts within period of performance: | ||
| EVALUATION AREA 4: PRICE/COST CONTROL | ||
| (Select the rating that applies from drop down menu) | ||
| Quality, completeness, and accuracy of price/cost proposals: | ||
| Accuracy and timeliness of cost reports: | ||
| Ability to perform within negotiated costs/prices: | ||
| Ability to provide innovative solutions that resulted in cost savings: | ||
| EVALUATION AREA 5: BUSINESS RELATIONS | ||
| (Select the rating that applies from drop down menu) | ||
| Ability to effectively manage contract: | ||
| Ability to choose and manage subcontractors: | ||
| EVALUATION AREA 6: CUSTOMER SATISFACTION | ||
| (Select the rating that applies from drop down menu) | ||
| Maintains a single effective point of contact to manage and resolve problems: | ||
| Effectiveness in interfacing with personnel in your organization: | ||
| Overall ability to resolve performance issues: | ||
| EVALUATION AREA 7: OVERALL CONTRACT PERFORMANCE | ||
| (Select the rating that applies from drop down menu) | ||
| Based on this contractor's overall performance, would you award this contractor another contract? | ||
| COMMENTS (Please include any additional comments concerning the past performance of the contractor): | ||
| Thank You for completing this past performance evaluation. Please email the completed survey to the following address: | ||
| U. S. Department of State | ||
| Office of Acquisition Management | ||
| Room 207, SA-6 | ||
| P.O. Box 9115, Rossyln Station, Arlington, Virginia 22219 | ||
| ATTN: Mr. Michael Mickaliger | ||
| PHONE: 703-875-6937 | ||
| E-MAIL ADDRESS: MickaligerMJ@state.gov |
&RRFQ S-AQMMA-08-Q-0145
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