Solicitation 693JJ925R000013 (Past Performance Questionnaire).pdf

693JJ925R000013

Standards Enforcement Program for FMVSS No. 106, "Brake Hoses"

PAST PERFORMANCE QUESTIONNAIRE

Source Selection Sensitive (when completed)

OFFEROR:

1. REFERENCE INFORMATION FOR:

Contractor:

Contract Number:

Type of Contract: ( ) Fixed Price Type ( ) Cost-Reimbursement Type ( ) Other:

Period of Performance:

Contract Value: (initial) $ (current)$

2. CONTACT INFORMATION: Please provide the following information for the person(s) providing the reference (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary)

Name of Contact:

Phone & Fax Numbers:

Organization/Office:

Position Title/Grade:

Period of involvement in contract:

Questionnaire Completion Date:

PAST PERFORMANCE QUESTIONAIRE

For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment lines may be used to provide any additional information deemed noteworthy).

High Low

1. QUALITY OF SERVICE: 5 4 3 2 1

This area deals with compliance of contract requirements, to include appropriateness of personnel and technical excellence.

High Low

2. TIMELINESS OF PERFORMANCE: 5 4 3 2 1

This area deals with the contractor’s ability to meet milestones and delivery schedules, to include responsiveness to technical direction, completion of efforts on time including wrap-up and contract administration.

High Low

3. PRICE/COST CONTROL: 5 4 3 2 1

This area deals with the contractor’s ability to control price/cost escalation during performance to include appropriate budgetary estimates, current/accurate/complete billings/invoices, relationship of negotiated costs to actual, claim submissions, cost efficiencies, and change order issues.

High Low

4. CUSTOMER SATISFACTION: 5 4 3 2 1

This area deals with the contractor’s commitment to satisfaction and cooperative/reasonable businesslike behavior with own staff and customers to include: effective management, responsiveness to clients or Government program personnel, operates with honesty and integrity, prompt notification of problems, flexible and proactive qualities, effective contractor-recommended solutions, and effective subcontracting and teaming arrangements.

Comments (attach additional pages as necessary):

GENERAL INFORMATION: Please provide answers to the following questions.

5. Has the contractor ever been given a cure notice, show cause notice, suspension of progress payments, or other letters directing the correction of a performance problem; or has this contract been partially or completely terminated, or is there any pending termination actions? ( ) No ( ) Yes

If yes: ( ) Default ( ) Convenience; and please explain:

6. Changes in contract dollar value throughout the life of the contract are/were attributable, for the most part, to:

( ) Government-issued change orders ( ) claims submitted by the contractor ( ) other Government actions ( ) other contractor actions (please explain below)

7. Based on this contractor’s overall performance, would you award this contractor another Government contract?

( ) Yes ( ) No If no, please explain:

8. If any of the above responses are based on adverse past performance, have you discussed it with the contractor and has the contractor had an opportunity to comment?

( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain: