SAQMMA15R01112_SECTION_J _ATTACHMENT_K_-_Past_Performance_Questionnaire.docx
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- Operation and Maintenance Support Services at Department of State, New Hampshire facilities
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- SAQMMA15R0112
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Section J Attachment K Past Performance Questionnaire
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PERFORMANCE QUESTIONNAIRE
Your assistance is requested in support of a source selection.
Please complete this Questionnaire and mail to:
Department of State – Office of Acquisition Management
A/LM/AQM/IT/ISB
ATTN: LEE, AMY S.
PO BOX 9115, Rosslyn Station Arlington, VA 22219 Or leeas@state.gov (this is preferable method of receipt) Office Tel: 703-516-1560 Date:
When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.
TO BE COMPLETED BY OFFEROR
1. CONTRACTOR NAME & ADDRESS:
2. CONTRACT NO.:
3. CONTRACT INITIATION DATE:
4. COMPLETION DATE:
5. CONTRACT VALUE (with options): $
6. TYPE OF CONTRACT:
7. DESCRIPTION OF CONTRACT REQUIREMENTS:
Please add a continuation page if additional space necessary.
TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE
8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION: DVIDS Director
b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:
Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.
O = Outstanding E = Excellent A = Adequate M = Marginal P = Poor N/O = Not Observed
A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).
O E A M P N/O
B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project.
O E A M P N/O
C. Schedule – Assess the timeliness of contractor against the schedule of activities.
O E A M P N/O
D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.
O E A M P N/O
E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.
O E A M P N/O
F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.
O E A M P N/O
G. Overall Assessment.
O E A M P N/O
If an Award Fee contract, what was the average Award Fee % earned?
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