SAQMMA16R0222_Attachment_E_Past_Performance_Survey.xlsx

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Telecommunications Services - U. S. Embassy Ottawa
Solicitation number
SAQMMA16R0222
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Attachment E Past Performance Survey - for mandatory use in proposal submission

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Customer Satisfaction Survey

PAST PERFORMANCE SURVEY
Introduction: The United States Department of State (DOS) is currently conducting a competitive procurement for its Telecommunications and Mobile Phone Services supporting U.S. Embassy Ottawa 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.
PART I - CONTRACT INFORMATION
a. Contractor:XXXXX
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:Negotiated
ii. Competitive or Non-Competitive:Competitive
iii. Firm-Fixed-Price, Cost-Plus, Time-and-Materials/Labor Hour, Hybrid, or Other:Firm-Fixed-Price
iv. Indefinite Quantity, Requirements, or neither:Indefinite Quantity
f. Contract Period of Performance:
h. Initial Contract Value: $
i. Current (or Completed) Contract Value: $
j. Brief Description of the Contract Requirement:

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

PART II - GOVERNMENT PAST PERFORMANCE/CUSTOMER SATISFACTION EVALUATION
EVALUATION RATINGS
EXCELLENT: Indicates the Contractor's performance within the area of evaluation clearly and consistently exceed contractual requirements.
SATISFACTORY: 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: 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:
Demonstration of reasonable and cooperative behavior in dealing with clients
Effectiveness and reliability of contractor's key personnel:
EVALUATION AREA 2: COMPLIANCE WITH SCHEDULES
(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 3: PRICE/COST CONTROL
(Select the rating that applies from drop down menu)
Quality, completeness, and accuracy of price/cost proposals/invoices:
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 4: MANAGEMENT EFFECTIVENESS
(Select the rating that applies from drop down menu)
Effictiveness in managing and directing contract resources:
Ability to work in collaboration with other contractors towards a common goal:
Ability to choose and manage quality subcontractors:
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
Demonstrated support for developing small business capabilities through mentoring campaigns
EVALUATION AREA 7: COMPLIANCE WITH REGULATORY REQUIREMENTS
(Select the rating that applies from drop down menu)
Adherence with regulatory requirements of contract
Proactive engagement to identify regulatory requirements
Proactive engagement to identify regulatory requirement risks
Proactive engagement to mitigate regulatory requirement risks
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
ATTN:

David Ziemba

E-MAIL ADDRESS:

ziembade@state.gov

SAQMMA-16-R-0222

Attachment E - Past Performance Survey

&P

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