Past_Performance_Questionnaire.docx

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

RFP Number Please provide the following information about yourself:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program Manager):__________________________________________________________________________ Agency or Business: _________________________________________________________________ Address: ___________________________________________________________________________ Telephone Number __________________ Fax Number _________________________ Return your completed questionnaire either electronically, by fax or by Email. (PCO Note: tailor to match your Section L language). See Section L of the solicitation for appropriate email address, mailing address, or fax number. Notice: When completed, this questionnaire will be considered source selection sensitive information IAW FAR 3.104.

PART I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________ CAGE Code: __________ Program Title and Brief Description: _________________________________________________________________________________________________________________________________________ Role in the Program/Work Performed As: _____Prime _____Subcontractor _____Vendor/Supplier Contract Number: _________________ Number of Years?: Basic:________ Option: _________ Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, etc.__________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

Period of Performance:

1. Original Schedule (assuming all options exercised): Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised): Beginning Date _________ through ____________

3. Reason for difference (if applicable) ____________________________________________ (WHEN COMPLETED) SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104. FOR OFFICIAL USE ONLY Contract Dollar Value:

1. Original MAX Contract $ Value (assuming all options are exercised: _____________________

2. Current MAX $ Value (assuming all options exercised): _______________________________

3. Primary Causes of Changes: _______________________________________________________ Note: In Part III., should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 4 of 5.

PART III. PERFORMANCE ASSESSMENTS. (Question should be tailored to match you factors and subfactors) Please check the appropriate rating for each of the following questions:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

1. Extent to which the Company’s products and/or services met the specification /performance requirements:

2. Configuration management (first product delivered same as last):

3. Quality of Completed Product:

4. Overall management of subcontracting efforts:

5. Quality of technical manuals or commercial manuals:

6. Customer’s Satisfaction with warranty response times and corrective actions:

7. Adequate number of dedicated resources for your program:

8. Timely recognition and notification of administrative, engineering, production, problems affecting the program:

9. Company performed independently without significant customer direction/oversight?

10. Monitoring of program schedules and critical milestones:

11. Completed work on time:

12. Company demonstrated positive responsiveness to unscheduled requirements or contract changes:

13. Ability to meet forecasted cost and perform within contract costs.

14. Ability to meet delivery dates.

15. Ability to meet or exceed small business and small disadvantage business goals set forth in the approved subcontracting plan.

16. Has action been initiated to cancel or terminate the contract for default? If yes, explain. _______________________________________________________________________________

17. Have there been any disputes/claims relative to the contract? If yes, explain.

18. Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract. ________________________________________________________________________________

19. If given a choice, would you award to this contractor again? If not, please explain. ___________________________________________________________________________________

20. Do you feel you “got what you paid for”? Please explain. ______________________________________________________________________________

21. Additional Remarks.