ATTACHMENT_J.5_PAST_PERFORMANCE_QUESTIONNAIRE.docx
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- Attached to
- Ukraine Health Reform Support Program Federal contract opportunity
- Solicitation number
- SOL-121-17-000009
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ATTACHMENT J.5 PAST PERFORMANCE QUESTIONNAIRE
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ATTACHMENT J.5 - PAST PERFORMANCE QUESTIONNAIRE
REQUEST FOR PROPOSALS No.: SOL-121-17-000009
Please fill out the following questionnaire as clearly and as objectively as possible. The information you provide will be used for source selection purposes.
The Past Performance Questionnaire will be used to collect information concerning the past performance of the Offeror and any major subcontractor and/or teaming partner. The Offeror shall forward copies of this Questionnaire to three of its customers and to three customers of each major subcontractor and/or teaming partner proposed, for which the prime/major subcontractor performed relevant work within the past three years, requesting the Customers to return the completed Questionnaires directly to the USAID/RCO in Ukraine by e-mails at: llomonosova@usaid.gov and rroe@usaid.gov and by the closing date and time of the solicitation.
Offerors are not required to submit completed copies of the Questionnaire as part of their Technical Proposals, and the proposals will not be considered late if this deadline is not met by any of the respective Customers. While the Government will consider data obtained from other sources, the burden of providing relevant references that the Government can readily contact shall rest with the Offeror.
PAST PERFORMANCE QUESTIONNAIRE
| 1. Contractor Name: |
| 2. Prime or Subcontractor on the project: |
| 3. Project Name: |
| 4. Project Description: |
5. Period of Performance:
6. Dollar Amount of Award:
7. Name of Person Providing Feedback:
8. Date:
| 9. E-mail and Phone Number: |
| 10. Employer: |
9. Contact’s Role or Knowledge of the Project:
11. Complexity of Work: Difficult: _______ Routine: ____________
NOTE: Please rate the contractor using one of the following adjectival ratings:
Poor, Fair, Good, Excellent, Outstanding
| Evaluation Factor |
| a. Comments (Attach additional sheets, if necessary.) |
| b. Adjectival Rating |
12. Quality of Work
13. Timeliness of Performance
14. Quality of Business Relations
15. Cost/Budget Control
16. Performance of Key Personnel
17. Retention of Key Personnel
18. Would you select this firm again? Please explain. (Attach additional sheet if necessary.)
19. Additional Comments (Attach additional sheet if necessary.)
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