PAST_PERFORMANCE_QUESTIONAIRE.pdf

(Offeror to distribute to Customer listed on Contractor Performance Questionnaire for Past Performance

Assessment)

(Page 1 of 4)

PAST PERFORMANCE QUESTIONNAIRE

The contractor listed below is being considered for a contract award by DLA Maritime Puget Sound, Bremerton, WA. Your comments regarding this contractor’s past performance are appreciated.

This questionnaire must be received by the DLA Maritime Puget Sound

Contracts Office no later than the due date of the Request For Proposal, which is:

DD MMM YYYY

PLEASE NOTE: Contractors may be advised of adverse remarks and given the opportunity to respond per the

Federal Acquisition Regulation requirements. However, the contracting officer will not provide your name or questionnaire to the contractor. The results of the questionnaires are reserved strictly for the source selection.

To maintain the integrity of the source selection process, we request that you do not divulge the name of the contractor nor discuss your questionnaire comments with the contractor or any other individuals.

PROJECT TITLE: _________________________ – Solicitation ______________________

DATE OF EVALUATION:

PAST PROJECT

INFORMATION:

Name and Address of Contractor/Offeror being Evaluated:

Contract Number, Project Title, and Location:

After completing the Past Performance Questionnaire, please forward it directly to:

FORWARD DIRECTLY TO

THE DLA MARITIME

CONTRACTS OFFICE VIA

EITHER:

1) E-MAIL

2) FAX

Email Address: Susan.Peterson@DLA.mil

Fax

DLA MARITIME

CONTRACTING OFFICE

INFORMATION

DLA MARITIME PUGET SOUND

Attn: Susan Peterson

467 W Street, 2nd Floor

Bremerton WA 98314-5100

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PAST PERFORMANCE QUESTIONNAIRE

Contract Type:

Original Contract Value:

Current Contract Value:

Period of Performance (including any options exercised)

Brief Scope of Work:

EVALUATOR (this information will be kept confidential):

Name:

Title/Position Held during the Project:

Activity/Location:

Phone Number:

Email Address:

QUESTIONNAIRE RATINGS

(Please evaluate the contractor’s performance using the following ratings):

For questions 1 through 4, and sections III and VII a “yes”, “no” or “N/A” answer is sufficient. A brief explanatory comment, if appropriate, is appreciated. For questions in sections I through VI choose a number on the scale of 1 to 5, with 1 representing “unsatisfactory”, 2 representing

“marginal”, 3 representing “satisfactory”, 4 representing “very good” and

5 representing “exceptional” performance. Circle the number that most accurately describes the Contractor’s performance, or N/A for “not applicable”. Please add any comments and information (in the space provided on the last page) that may help to determine the Contractor’s probable future performance. Be sure to include the number of the item on which you comment.

QUESTIONS – Please rate and provide any supporting information for the following questions:

RATING:

1 Would you award similar contracts to the Contractor in the future?

Y N N/A

2 Were any tasks or deliverable items cancelled due to the Contractor’s inability to meet the work requirements or cost objective?

3 Was the Contractor cooperative in negotiations and resolving issues?

4 Have any instances of adverse actions such as the assessment of liquidated damages or issuance of Cure Notices, Show Cause Notices, and Delinquency Notices been issued?

(Page 3 of 4)

PAST PERFORMANCE QUESTIONNAIRE

QUESTIONS – Please rate and provide any supporting information for the following questions:

RATING:

I Quality of Product or Service: 1 2 3 4 5 N/A

1. Compliance with contract/task order terms and conditions: 1 2 3 4 5 N/A

2. Adherence to accepted technical and professional standards: 1 2 3 4 5 N/A

3. Ability to identify and solve problems expeditiously: 1 2 3 4 5 N/A

4. Contractor Services required little or no rework: 1 2 3 4 5 N/A

5. Effectiveness of work control procedures: 1 2 3 4 5 N/A

6. Reports were accurate and complete: 1 2 3 4 5 N/A

II Schedule 1 2 3 4 5 N/A

1. Adherence to task schedules and/or milestones: 1 2 3 4 5 N/A

2. Timeliness of reports required by contract: 1 2 3 4 5 N/A

3. Timeliness of estimates: 1 2 3 4 5 N/A

4. Timeliness of invoices: 1 2 3 4 5 N/A

III Cost Control 1 2 3 4 5 N/A

1. Contractor exceeded initially awarded contract or task order prices: Y N N/A

2. Contractor keeps within total estimated costs (relationship between negotiated costs and actual costs):

Y N N/A

3. Accuracy and completeness of invoices: 1 2 3 4 5 N/A

4. Contractor labor and/or indirect costs have increased more than evaluated or expected:

1 2 3 4 5 N/A

5. Contractor submitted requests for equitable adjustment and/or claims under the contract or task order Y N N/A

IV Management/Business Relations 1 2 3 4 5 N/A

1. Contractor exhibits reasonable and cooperative behavior (to include timely identification of issues in controversy):

1 2 3 4 5 N/A

2. Overall performance in planning, scheduling and monitoring: 1 2 3 4 5 N/A

3. Ability to effectively manage multiple tasks from planning through execution:

1 2 3 4 5 N/A

4. Timeliness, completeness and quality of problem identification and corrective action plans:

1 2 3 4 5 N/A

5. Timeliness/Responsiveness to Government Requests: 1 2 3 4 5 N/A

6. Overall communication with the Government: 1 2 3 4 5 N/A

(Page 4 of 4)

PAST PERFORMANCE QUESTIONNAIRE

QUESTIONS – Please rate and provide any supporting information for the following questions:

RATING:

V Personnel Resources 1 2 3 4 5 N/A

1. Personnel assigned to key positions matched Contract/task key position qualification requirements:

1 2 3 4 5 N/A

2. If key personnel were replaced, replacement’s qualifications met or exceeded requirements of the key position 1 2 3 4 5 N/A

VI Overall Performance

1. How would you rate the contractor’s overall technical performance on this contract:

1 2 3 4 5 N/A

2. How would you rate the contractor’s overall management performance on this contract:

1 2 3 4 5 N/A

3. How would you rate the contractor’s overall performance on this contract:

1 2 3 4 5 N/A

VII Small Business Utilization. Answer the following questions:

1. Does this contract include a subcontracting plan? Y N N/A

2. Is contractor meeting all subcontracting targets?

Additional comments (this section provides space to comment on any of the answers in 1-4 and sections I-VII. Please put appropriate number next to comment. Any other comments are also welcome in this section):