Amended_Past_Performance_Questionnaire.doc

SP4702-15-R-0023

Attachment 1

PAST PERFORMANCE QUESTIONNAIRE (SERVICES) SP4702-15-R-0023

PART I: FOR COMPLETION BY OFFEROR. OFFERORS SHOULD COMPLETE ONE COPY OF THIS FORM FOR EACH REFERENCE PROVIDED.

Name of Individual/Firm being evaluated:

Name of Firm/Agency for which the referenced work was performed:

Was this work with a: Commercial Fed. Govt Local/state Govt entity.

Firm’s/Agency address:

Name, Title, Employer and Contact Information for Individual Providing Reference:

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Period of Performance: _

Contract/Task Order Award Date:

Contract/Task OrderCompletion Date:

Check Contract Type: Fixed Price (FP)_ Labor Hour_ Time and Material_

Contract/Task Order Amount: Prime Contractor: YES NO The contract number and services provided:

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Relevance of the referenced contract to the current requirement:

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PART II: FOR COMPLETION BY REFERENCE. References are asked to complete all items set forth in this Part II and return the completed form by email to

@dla.mil" Laura.Cherryholmes@dla.mil or directly to the address shown below. The past performance questionnaire is due with the Solicitation.

DLA Contracting Services Office - Columbus ATTN: DSCO-C Laura Cherryholmes /020-A2N112 3990 East Broad Street Columbus, OH 43213

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor’s control). An individual within your organization that is knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

Name of Respondent:

Position and Title:

Telephone Number: FAX Number:

Email Address:

Address:

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Date Questionnaire was Completed:

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Detailed description of Work/Requirement:

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The following chart depicts the ratings that are to be used to evaluate the contractor’s performance:

H A

MA

D N Highly Acceptable Acceptable Marginally Acceptable Deficient Neutral Performance met all contract requirements and exceeded many. Problems, if any, were negligible, and were resolved in a timely and highly effective manner.

Performance met contract requirements. There were some minor problems; corrective actions taken by the contractor were satisfactory.

Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

Performance did not meet contractual requirements . There were serious problems, and the contractor’s corrective actions were ineffective.

No record of past performance or the record is inconclusive.

When responding to the questions listed, circle the letter that most accurately describes the contractor’s performance or situation. For any deficient rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, circle N. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly.

Your time and effort in providing this vitally important information are greatly appreciated.

PERFORMANCE ELEMENTS:

Quality 1.

Contractor’s ability to meet minimum quality standards specified for performance.

HA

A

MA

D N 2.

Contractor’s ability to effectively control the quality of services provided.

HA

A

MA

D N

3.

Contractor’s compliance with contractual terms and conditions.

HA

A

MA

D N 4.

Overall rating of contractor’s standard of workmanship.

HA

A

MA

D N 5.

Overall rating of contractor’s quality of service.

HA

A

MA

D N Responsiveness/ Timeliness 1.

Contractor’s ability to meet specific response times and scheduled time frames for completion of specific tasks.

HA

A

MA

D N 2.

Contractor’s responsiveness/timeliness for providing administrative reports/documents required by the contract.

HA

A

MA

D N 3.

Contractor’s adherence to delivery schedules?

HA

A

MA

D N 4.

Contractor’s timeliness in responding to emergency service requirements.

HA

A

MA

D N 5.

Overall rating of contractor’s responsiveness/timeliness.

HA

A

MA

D N Business Relations 1.

Contractor’s ability to identify problems and potential problems, and promptly notify the Contracting Officer.

HA

A

MA

D N 2.

Contractor’s ability to correct problems and prevent or mitigate potential problems in a timely manner.

HA

A

MA

D N 3.

Contractor’s willingness to improve and correct noncompliance issues or concerns.

HA

A

MA

D N 4.

Contractor’s ability to use effective approaches and provide technical expertise and resources to solve contract problems.

HA

A

MA

D N 5.

Extent to which the contractor has demonstrated reasonable and cooperative behavior.

HA

A

MA

D N 6.

Contractor’s effectiveness in interfacing with the Contracting Officer, quality assurance personnel, and customers.

HA

A

MA

D N 7.

Contractor’s flexibility in satisfying the requirements of its customers.

HA

A

MA

D N 8.

Extent to which the contractor provided prompt and courteous service when responding to customer complaints.

HA

A

MA

D N 9.

Overall rating of customer satisfaction.

HA

A

MA

D

10.

Overall rating of business relations.

Management

HA

A

MA

D N 1.

Contractor’s ability to select and retain cooperative and

HA

A

MA

D effective key personnel, such as the contract manager and quality control personnel.

2.

Extent key personnel were knowledgeable about contractual

HA

A

MA

D requirements.

3.

Contractor’s ability to meet appropriate staffing levels with

HA

A

MA

D qualified personnel in order to provide required services.

4.

Rate the contractor’s ability to provide continuity of key

HA

A

MA

D personnel on the contract.

5.

Rate the contractor’s ability to replace key personnel in a

HA

A

MA

D timely fashion

6.

Contractor’s ability to effectively manage subcontractors.

HA

A

MA

D N 7.

Rate the level of the functional expertise of the contractor’s staff.

8.

Overall rating of contractor’s management of key personnel.

HA

A

MA

D

General

Has an election ever been made not to exercise an option or continue relations due to contractor’s poor performance?

YES NO

Has a cure notice or show cause notice ever been issued? YES NO

Has this contract been partially or completely terminated for default or convenience?

Partially Completely

YES NO

Are there any pending terminations? YES NO

Overall rating of contractor’s performance under this contract.

HA A M D N A

Would you hire this contractor again? YES NO

*REMARKS

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PART 3: FOR COMPLETION BY GOVERNMENT:

If taken by phone, name and title of the person conducting the interview: _ Date: