Past_Performance_Questionnaire.doc

SSA-RFP-16-1005

Attachment 3

PAST PERFORMANCE QUESTIONNAIRE

PART 1: To be completed by Offeror:

Name of Offeror: _________________________________________________________

Name of Vendor/Agency providing Past Performance Information:

Contract Number or Project Title: ____________________________________________ Contract/Project Period of Performance: _______________________________________

PART 2: To be completed by person providing reference:

Name: __________________________________

Phone: _________________________

Agency/Organization: _____________________________________________________________ Position/Title: ____________________________________________________________________ Relationship to Contract (Contracting Officer, Project Officer, Etc.)__________________________ Brief Description of Services Provided: _______________________________________________________________________________ _______________________________________________________________________________

Assign one of the below ratings and provide comments for each of the areas for which information is requested.

You may attach additional comments if desired.

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

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

2 - 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.

1 - Marginal- Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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.

0 - 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

QUALITY OF SERVICE

1. How would you rate the contractor’s compliance with the contract requirements?

Rating:

N/A

Comments:

2. Were the services delivered of high quality?

YES ( )

NO ( ) If no, explain:

Comments:

3. How would you rate the contractor’s commitment to customer satisfaction?

Rating

N/A

Comments:

COST CONTROL

4. Did the contractor submit their invoices/bills timely and accurately?

YES ( )

NO ( ) If no, explain:

Comments:

5. Was this contractor cost efficient?

YES ( )

NO ( ) If no, explain:

Comments:

6. Did this contractor have discrepancies between the negotiated costs and actual costs submitted?

YES ( )

NO ( ) If yes, explain:

Comments:

TIMELINESS OF PERFORMANCE

7. How would you rate the contractor's adherence to contract schedules, including timeliness?

Rating:

N/A

Comments:

8. How would you rate the contractor’s responsiveness to technical direction?

Rating

N/A

Comments:

BUSINESS RELATIONS

9. How would you rate the contractor’s business relations? (effective and efficient management, businesslike correspondence, responsiveness, notification/resolution of problems, reasonable/cooperative behavior, flexibility, proactive, effective and efficient recommended solutions, etc.)

Rating

N/A

Comments:

10. Was this contractor assessed liquidated damages or performance penalties; given a cure notice or show cause letter; or terminated for any reason?

YES ( )

NO ( ) If yes, explain:

Comments:

PERSONNEL MANAGEMENT

11. How would you rate the contractor’s performance in management of personnel? (Effective and efficient management of work force; work force properly trained and given proper directions, responsive to contract requirements, reasonable/cooperative behavior; etc.)

Rating

N/A

12. How would you rate the contractor’s ability to recruit and maintain qualified and reliable personnel?

Rating

N/A

Comments:

13. On-site Contract Manager’s level of authority:

A. Could he/she make immediate, appropriate decisions regarding the project?

YES ( )

NO ( ) If no, explain:

Comments:

B. Did this person have to elevate it to a higher authority?

YES ( )

NO ( ) If yes, explain:

Comments:

14. Has the contractor provided comprehensive supervision and quality control?

YES ( )

NO ( ) If no, explain:

Comments:

SUBCONTRACTOR UTILIZATION

15. How would you rate the contractor’s performance in management of subcontractors? (effective and efficient management of subcontractors, utilization of quality subcontractors, etc.)

Rating

N/A

Comments:

OVERALL PERFORMANCE

16. How would you rate the contractor's OVERALL PERFORMANCE on this effort?

Rating

17. Based on this contractor's overall performance, would you award this contractor another similar contract?

YES ( )

NO ( )

Comments:

Thank you.

Please email your completed questionnaire to: Aminta.Freeman@ssa.gov