ATTACHMENT_V_-_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE

QUESTIONNAIRE SPE600-17-R-5X03

ATTACHMENT V

Note: The past performance questionnaire consists of a total of ten (10) pages

CONTRACT INFORMATION (Offeror to complete blocks 1-4)

1. Contractor Information:

CONTRACTOR NAME: CCR CAGE CODE:

ADDRESS: CCR DUNs NUMBER:

PHONE NUMBER:

EMAIL ADDRESS:

POINT OF CONTACT: CONTACT PHONE NUMBER:

2. Work Performed as: ______ Prime Contractor ______ Sub Contractor ______ Join Venture ______ Other (Explain)

If subcontractor, who was the prime (Name/Phone#):

3. Contract Information

Contract Number:

Contract Type: _________ Firm Fixed Price __________ Cost Reimbursement _________ Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

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SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104

4. Contract Description:

Complexity of Work: ________ High ________ Med _________ Routine

How is this contract relevant to the requirement of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Reference to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the reference’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

The Government requests that the reference completes this Past Performance Questionnaire and submits directly to the Government. Completed Questionnaire should be submitted to the following email address:

Joy Mack joy.mack@dla.mil

GENERAL GUIDANCE FOR COMPLETING QUESTIONNAIRE

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A. The questionnaire should be completed by the individual most knowledgeable of the Contractor’s day-to-day operations and overall condition of service being rendered. However, that individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others in their organization, as applicable.

B. Handwritten responses are sufficient. However, request they be legible.

C. Please provide explanatory narratives for as many responses as possible. These narratives need not be lengthy, just descriptive. Space for narrative comments is included after each question and on the last page of the survey. If more space is needed, use the back of the survey or attach additional pages.

D. As the survey relates to an ongoing source selection for the services identified in the cover letter, request that all information provided within the survey be safeguarded against unauthorized disclosure.

E. The following description should be used as a guide in providing element ratings:

5 = EXCEPTIONAL

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 = VERY GOOD

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 = SATISFACTORY

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

2 = MARGINAL

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

1 = UNSATISFACTORY

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

PAST PERFORMANCE QUESTIONNAIRE

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The following questions are two (2) types: YES/NO and RATING. The YES/NO questions should be supplemented with an explanatory narrative if the answer is “YES”. When responding to the RATING type questions, choose the number on the scale of 1 to 5 which most accurately describes the Contractor’s performance or situation. If the question is not applicable, circle “N/A”. Responses to the RATING type questions should be supplemented with explanatory narrative as well, if necessary. The numbers 1 to 5 correspond with the following values:

1 = Unsatisfactory 2 = Marginal 3 = Satisfactory 4 = Very Good 5 = Exceptional

SCHEDULE

01. Was the Contractor responsive and timely in providing the required services? YES NO N/A 1 2 3 4 5

02. Was the Contractor responsive and timely to administrative functions of the contract?

YES NO N/A

1 2 3 4 5

03. Was the Contractor responsive and timely responding to questions or correspondence?

YES NO N/A

1 2 3 4 5

04. Was the Contractor in compliance with contract terms and conditions? YES NO N/A 1 2 3 4 5

05. Were any contract concessions/changes/terminations made due to the contractor’s failure to accurately plan? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

MANAGEMENT OF KEY PERSONNEL

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06. Did the Contractor appropriately prepare & train the personnel? YES NO N/A 1 2 3 4 5

07. Did the Contractor effectively manage subordinates? YES NO N/A 1 2 3 4 5

QUALITY OF SERVICES

08. Did the Contractor assimilate & accommodate changes in contractual requirements and/or priority effectively?

YES NO N/A

1 2 3 4 5

09. Did the Contractor exhibit knowledge of and comply with Government (or other) regulations?

YES NO N/A

1 2 3 4 5

10. Did the Contractor demonstrate technical expertise in providing all contractual services?

YES NO N/A

1 2 3 4 5

11. Did the Contractor possess/utilize tools/equipment necessary to adequately provide the required services?

YES NO N/A

1 2 3 4 5

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QUALITY OF SERVICES (CONTINUED)

12. Did the Contractor meet the standard for:

(a) Technical Performance? YES NO N/A

1 2 3 4 5

(b) Administrative Performance? YES NO N/A 1 2 3 4 5

(c) Safety & Health? YES NO N/A 1 2 3 4 5

13. Has the Contractor ever failed to effectively control the quality of services provided? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

14. Has a Contract Discrepancy Report (or equivalent) ever been issued? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

15. Has a Cure Notice or Show Cause Letter ever been issued? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

16. Have there been any disputes/claims relative to the contract? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

17. Has the Contractor demonstrated the ability to correct any of the problems for questions 14 through 16? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

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QUALITY OF SERVICES (CONTINUED)

18. Has the contract been terminated for default? YES NO N/A 1 2 3 4 5

19. Has an election ever been made to not exercise an option due to the Contractor’s poor performance? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

BUSINESS RELATIONS

20. Did the Contractor satisfactorily manage subcontracts? YES NO N/A 1 2 3 4 5

21. Have there been any labor disputes? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

22. Have there been any violations of Public Law, especially the Service Contract Act? (If you answered “YES”, please provide an explanation).

YES NO N/A

1 2 3 4 5

23. Did the Contractor consistently provide prompt and courteous service? YES NO N/A 1 2 3 4 5

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BUSINESS RELATIONS (CONTINUED)

24. Did the Contractor promptly and courteously resolve customer complaints? YES NO N/A 1 2 3 4 5

25. Did the Contractor’s actions show an overall commitment to customer satisfaction?

YES NO N/A

1 2 3 4 5

26. Did the Contractor satisfactorily provide overall cooperation relative to this contract?

YES NO N/A

1 2 3 4 5

27. How would you rate the integration and coordination of all activity needed to perform this contract?

YES NO N/A

1 2 3 4 5

28. Did you feel that the Contractor’s overall performance was satisfactory? YES NO N/A 1 2 3 4 5

29. Would you award similar contracts to this Contractor? YES NO N/A 1 2 3 4 5

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REMARKS:

Please use this space if you needed more room than provided under the question. Label the remark with the applicable question number that it relates to.

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Please list other known references regarding the Contractor’s performance:

TELEPHONE/

NAME ADDRESS FAX NUMBERS

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