Exhibit O - Past Performance Questionnaire.docx

Solicitation # S-AQMMA-10-R0134 Banjul, The Gambia

Exhibit O – Past Performance Questionnaire

Solicitation # S-AQMMA-11-R0002 Banjul, The Gambia

Exhibit O – Past Performance Questionnaire

1. Copies of recently issued (within last 2 years) DS 1771 Past Performance Evaluation are suitable substitute

2. Please complete this questionnaire based on the following guidance:

2.1. Handwritten responses are sufficient.

2.2. Indicate, based on the codes below, the contractor’s performance on the identified program. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

Performance Level CODE

EXCEPTIONAL ` (E) Indicates that the contractor’s performance within the area of evaluation clearly exceeds contractual requirements.

SATISFACTORY (S) Indicates no problems exist in the area of evaluation or has only minor problems for which solutions are in hand.

MARGINAL (M) Indicates the area of evaluation contains an existing problem for which there is doubt whether the identified solution is adequate but the problem appears to be within the contractor’s ability to solve.

UNSATISFACTORY (U) Indicates a serious problem exists in the evaluation area which may be outside the contractor’s ability to solve. The contractor is in danger of not being able to satisfy contractual requirements and timely recovery in not likely.

NOT APPLICABLE (N/A) Performance did not include such efforts or performance was not observed.

COMMENTS (C) Place an “X” in this column if additional written comments were add in the Paragraph V Comments.

1.3. Please circle a letter corresponding to your rating or ‘N/A’ if you are unable to provide a rating for an area.

1.4. FOR ANY RATING BELOW SATISFACTORY, A CLARIFICATION AND EXPLANATION IS REQUESTED. IF MORE SPACE IS NEEDED, USE THE BACK OF THIS QUESTIONNAIRE.

1.5. You are urged to supplement your knowledge of the contractor’s performance with the judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other similar programs for which your activity has contracts with this offeror.

1.6. Please return completed questionnaire to the requestor in a sealed envelope with the responder’s signature over the seal. They must include this questionnaire as a requirement of their proposal submission.

If you have any questions, please contact Tracy Babst-Wiedenbrug at Babst-WiedenbrugTX@state.gov.

I. PROGRAM IDENTIFICATION

A. CONTRACTORS NAME: _____________________________________

(Company name/Division)

B. CLIENT’S NAME: ________________________________________

C. CONTRACT NUMBER: ____________________________________

D. CONTRACT EFFORT OR PROGRAM TITLE: ______________________

E. BRIEF DESCRIPTION OF CONTRACT EFFORT OR TASK:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________No.Guards:____________________________________________________

F. CONTRACT TYPE: _________________________________________

(FIXED PRICE/COST REIMBURSABLE OR OTHER)

G. ESTIMATED AMOUNT/ANNUAL VOLUME OF SERVICE:

H. PERIOD OF PERFORMANCE: _______________________________

II. PAST PERFORMANCE EVALUATION

QUALITY CONTROL

COST/PRICE

III. GENERAL

Given the opportunity, would your organization Yes No enter a contractual relationship with this contractor in the future?

IV. RESPONSE INFORMATION

THE FOLLOWING INFORMATION WILL ASSIST IN THE ANALYSIS OF THE DATA. THIS INFORMATION WILL BE KEPT CONFIDENTIAL.

Location address: ______________________________________________

Email: ________________________________________________________

V. COMMENTS

NOTE: ADDITIONAL COMMENTS ARE ENCOURAGED.

Source Selection Sensitive – Subject to Non-Disclosure