ATTACHMENT A-RIC PP Questionnaire.doc

RFP #SBAHQ-10-R-0021

ATTACHMENT A

PROCUREMENT SENSITIVE

PAST PERFORMANCE

THIS FORM IS PROVIDED FOR THE PURPOSE OF PROVIDING TO

AND SUBMITTAL BY THE OFFEROR’S REFERENCES

PAST PERFORMANCE QUESTIONNAIRE FOR

RFP NUMBER SBAHQ-10-R-0021:

REGIONAL INNOVATION CLUSTERS

The contractor listed below is being considered in a Source Selection by the Small Business Administration, Division of Procurement & Grants Management, 409 Third St., S.W., Washington, DC 20416. It would be appreciated if you would provide us with comments regarding the contractor's past performance. Your comments are considered Source Selection Sensitive.

This form shall be faxed or emailed NLT 4:00 PM, EDT on August 16, 2010 to:

Gary Fontaine at (202) 292-3737, or email to gary.fontaine@sba.gov.

SMALL BUSINESS ADMINISTRATION (SBA)

CONTRACTOR’S PAST PERFORMANCE QUESTIONNAIRE

Section I - Details of Company Being Evaluated A. Contractor’s Information:

1. Company Name:

2. Address:

3. Company POC’s Name:

4. POC’s Title:

5. POC’s Phone #:

6. POC’s Fax #:

7. POC’s Email:

B. Information regarding Past Contract(s*) being evaluated: *(attach additional pages if necessary)

1. Contract #:

2. Customer (Firm Name):

3. Performance Period :

4. Location(s) of Work Performed:

5. Scope of Contract (i.e. Brief Description of Work Performed):

6. Total dollar ($) amount:

SECTION II - Details of Evaluator (Person providing Evaluation of Contractor)

1. Evaluator’s Name:

2. Title:

3. Organization:

4. Evaluator’s Phone #:

5. Evaluator’s Fax #:

6. Evaluator’s Email:

SECTION III (A) - Quality of Services Provided:

KEY: 5 = unsatisfactory, 4 = Marginal, 3 = satisfactory, 2 = Superior, 1 = No Rating (Note: Key defined on Page 22 of PPQ).

SECTION III (B.) - Timeliness of Services Provided:

KEY: 5 = Unsatisfactory 4 = Marginal 3 = Satisfactory 2 = Superior 1 = No Rating

SECTION III (C.) – Cost Control:

SECTION III (D.) – Technical Performance

11. Did the contractor use its quality control program effectively and follow contract quality assurance requirements adequately in order to complete your requirement within the Forecasted/negotiated timeframes? (If “No, was this due to the contractor’s fault?)

( Yes ( No

SECTION III (E.) – Program Management KEY: 5 = Unsatisfactory 4 = Marginal 3 = Satisfactory 2 = Superior 1 = No Rating

SECTION IV CLOSING COMMENTS

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Key Defined No Rating – The Contractor has no relevant past performance.

Superior – One or more examples where past performance significantly exceeded requirements.

Satisfactory – Past performance met requirements.

Marginal – One or more examples where past performance failed to meet requirements due to fault of contractor.

Unsatisfactory – One or more examples where past performance significantly failed to meet requirements due to fault of contractor.

PAGE