16R0106_A005_Attachment_12.pdf

SAQMMA-16-R-0106

Attachment 12 - Past Performance Survey

a. Contractor:

Demonstrated support for developing small business capabilities through mentoring campaigns

ii. Competitive or Non-Competitive:

iii. Firm-Fixed-Price, Cost-Plus, Time-and-Materials/Labor Hour, Hybrid, or Other:

Quality, completeness, and accuracy of price/cost proposals/invoices:

Accuracy and timeliness of cost reports:

Overall performance in planning, scheduling, and monitoring:

Completion of major milestones on schedule:

Timely completion of efforts within period of performance:

EVALUATION AREA 3: PRICE/COST CONTROL

(Select the rating that applies from drop down menu)

Effectiveness and reliability of contractor's key personnel:

Demonstration of reasonable and cooperative behavior in dealing with clients

EVALUATION AREA 2: COMPLIANCE WITH SCHEDULES

(Select the rating that applies from drop down menu)

EVALUATION AREA 1: QUALITY OF SERVICES

(Select the rating that applies from drop down menu)

Overall ability to proactively and aggressively perform contract requirements:

Overall ability to resolve performance issues:

i. Name:

ii. Telephone Number:

iii. Facsimile Number:

XXXXX

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 RATINGS

EXCELLENT: Indicates the Contractor's performance within the area of evaluation clearly and consistently exceed contractual requirements.

Negotiated Competitive

Firm-Fixed-Price

h. Initial Contract Value: $

c. Technical Point of Contact Information

b. Customer Name (Federal Agency or Other):

PAST PERFORMANCE SURVEY

PART I - CONTRACT INFORMATION

vi. Position Title/Grade:

e. Type of Contract

i. Negotiated or Sealed Bidding:

Office of Acquisition Management

ATTN:

David Ziemba

E-MAIL ADDRESS:

ziembade@state.gov

EVALUATION AREA 5: SMALL BUSINESS UTILIZATION

(Select the rating that applies from drop down menu)

Demonstrated support for small businesses through subcontracting opportunities:

Adherence to small business subcontracting goals

U. S. Department of State

(Select the rating that applies from drop down menu) Adherence with regulatory requirements of contract

COMMENTS (Please include any additional comments concerning the past performance of the contractor):

EVALUATION AREA 6: COMPLIANCE WITH REGULATORY REQUIREMENTS

Thank You for completing this past performance evaluation. Please email the completed survey to the following address:

Proactive engagement to identify regulatory requirements Proactive engagement to identify regulatory requirement risks Proactive engagement to mitigate regulatory requirement risks

Ability to provide innovative solutions that resulted in cost savings:

EVALUATION AREA 4: MANAGEMENT EFFECTIVENESS

Effictiveness in managing and directing contract resources:

(Select the rating that applies from drop down menu)

Ability to perform within negotiated costs/prices:

Ability to work in collaboration with other contractors towards a common goal:

MARGINAL: Indicates the Contractor's performance within the area of evaluation experienced minor problems for which solutions were satisfactory.

PART II - GOVERNMENT PAST PERFORMANCE/CUSTOMER SATISFACTION EVALUATION

Introduction: The United States Department of State (DOS) is currently conducting a competitive procurement for its Diplomatic Platform Support Services (DiPSS) supporting U.S. Embassies and U.S. Agencies world-wide for which the prospective offeror [XXXXX] has been requested to identify customers 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 prospective offeror or outside the Government.

Instructions: Please complete all areas of this form indicated in light yellow.

j. Brief Description of the Contract Requirement:

(Include a summary of the scope and complexity of the services provided.)

iv. E-mail Address:

d. Contract Number:

(Select responses from drop down menu)

Indefinite Quantity iv. Indefinite Quantity, Requirements, or neither:

f. Contract Period of Performance:

i. Current (or Completed) Contract Value: $

SATISFACTORY: Indicates the Contractor's performance within the area of evaluation met the contractual requirements.

v. Mailing Address:

Ability to choose and manage quality subcontractors: