Appendix_C_--_Past_Performance_Questionnaire.docx

SWHARC15Q0020 APPENDIX C

APPENDIX C - PAST PERFORMANCE QUESTIONNAIRE

Instructions: Transmittal Letter and Section 1 of the Past Performance Questionnaire to be completed by the Offeror and provided to the assessor. The assessor should complete Section 2 and submit Sections 1 and 2 directly to the Contracting Officer. The Offeror must submit with its proposal copies of the Transmittal Letter and Section 1 of all questionnaires as provided to assessors. Transmittal Letter must be on company letterhead.

INSERT DATE

SUBJECT: Past Performance Questionnaire for (PROGRAM TITLE/DESCRIPTION) concerning contract number(s) (CONTRACT AND ORDER NUMBER (IF APPLICABLE) TO BE EVALUATED). The effort was performed by (SPECIFIC ENTITY THAT PERFORMED THE WORK) under (CAGE code/DUNS#).

1. We are currently responding to the US Department of State Request for Quotation (RFQ) SWHARC15C0020, PGR Data Loss Prevention Solution Project. The Government is placing increased emphasis on past performance in order to obtain best value in source selections. The solicitation specifically requires that we, as an Offeror, send the attached questionnaire to several points of contact (POCs) on recent and relevant efforts that we (or a proposed subcontractor) have performed.

2. We have identified subject contract(s) as relevant to this acquisition and you as our POC. As such, please take a few moments of your time to fill out the attached questionnaire and forward it directly to the US Department of State. DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO US. The information contained in the completed Present/Past Performance Questionnaire is considered Source Selection Information (See FAR 2.101 AND FAR 3.104) and may not be released to us.

3. The completed Past Performance Questionnaire (Sections 1 and 2) should be sent directly to the US Department of State not later than (DATE TO BE INSERTED BY OFFEROR, PRIOR TO PROPOSAL DUE DATE AND TIME). The questionnaires should be emailed to LindquistRA@state.gov.

4. If you have any questions regarding the questionnaire, you may contact Robert A. Lindquist of the US Department of State at (954) 630-1283 or via email at LindquistRA@state.gov. Thank you for your timely assistance.

Sincerely, (TITLE AND NAME OF COMPANY OFFICIAL)

Attachment: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

SECTION 1 – TO BE COMPLETED BY OFFEROR

This Past Performance Questionnaire is submitted in response to Solicitation SWHARC15Q0020 (PGR Data Loss Prevention Solution Project) as part of <insert name of entity submitting proposal> proposal.

1. Company Information: Include name, address, and cage code of company (prime/subcontractor) performing under the contract identified below.

2. Program Title:

3. Contract Number (including Delivery / Task Order number if applicable):

4. Contract Award Basis: |_| Competitive |_| Non-Competitive

5. Contract Date:

6. Role: |_| Prime Contractor |_| Subcontractor |_| Other: (Specify)

If other than a prime contractor, provide the prime contractor’s name, address, and cage code:

7. Name and Address of Contracting Activity / Customer:

8. Primary Points of Contact: Offeror is responsible for exerting its best efforts to ensure that current information is provided for all individuals. If this is a commercial reference Offeror should change the Title, if appropriate, to commercial equivalents.

1. Contracting Officer

2. COR

3. Other (Please Specify)

9. Contract Type(s): List all that apply (e.g. FFP, FPIF, CPFF, CPIF, LH, T&M).

10. Contract Value:

a. Awarded Total Contract Value:

(Including all options)

b. Current Total Contract Value:

(Including all options)

c. Explanation for difference between awarded and current contract values:

11. Period of Performance:

a. Current (including all exercised options): MM/DD/YEAR to MM/DD/YEAR

b. Potential (including all options): MM/DD/YEAR to MM/DD/YEAR

12. Place of Performance: List all that apply.

13. Scope of work

a. Describe work performed by your company:

b. Relevancy: Provide information that demonstrates why this contract is relevant. Explain what aspects of performance under this reference are deemed relevant to the proposed effort and to what aspects of the proposed solicitation they relate to.

14. What were the key positive attributes about your performance?

15. What were the less than positive attributes and how were these resolved? The offeror is required to clearly demonstrate management actions employed in overcoming problems and the effects of those actions in terms of improvements achieved or problems rectified. Comment on any known performance deemed unacceptable to the customer, or not in accordance with the contract terms and conditions.

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

|_| Yes |_| No

If yes, please provide additional details:

17. Are there any pending terminations?

|_| Yes |_| No

If yes, please provide additional details:

SECTION 2 – TO BE COMPLETED BY ASSESSOR

Your feedback is requested by the US Department of State, Regional Procurement Support Office Florida. In efforts to expedite receipt of the requested information, the Contracting Officer respectfully requests that you do not mail hard copies. Instead, please e-mail the completed questionnaire (Sections 1 and 2) to LindquistRA@state.gov. Please contact Robert A. Lindquist at (954) 630-1283 should you have any questions.

EVALUATED BY:

1. Is the information completed by the Offeror in Section 1 of this questionnaire accurate, current, and complete?

|_| Yes |_| No

If no, please explain / correct:

2. Performance Evaluation

a. Quality of Products / Services:

1. Performance conformed to contract requirements, specifications, quality of product, and standards of good workmanship (e.g. commonly accepted technical, professional standards).

2. Contractor provided accurate and complete deliverables.

3. Contractor was proactive in identifying, notifying the Government, and resolving performance issues/concerns.

b. Schedule:

Rating (Acceptable / Unacceptable) Explanation

1. Contractor provided deliverables on time.

2. Contractor performed services in a timely manner.

c. Cost Control:

Rating (Acceptable / Unacceptable) Explanation

1. Contractor performed services within contract cost parameters.

2. Contractor invoiced in a timely manner with minimal corrections.

d. Business Relations:

(Acceptable / Unacceptable) Explanation

1. Contractor has a history of reasonable and cooperative behavior and effective business relations.

2. Contractor is dedicated to customer satisfaction.

3. Contractor effectively adapts to changes in contract requirements and priorities.

4. Contractor provides viable and timely proposals for contract modifications or task orders.

e. Management

(Acceptable / Unacceptable) Explanation

1. Effectiveness of integration and coordination of all activities required to execute the contract, use of resources, assignment of responsibility, internal coordination and communication, and risk management practices.

2. Contractor was able to select, retain, support, and replace personnel with the experience and expertise necessary to accomplish the Government’s requirements within schedule and budget.

3. Contractor effectively identifies and resolves problems related to the contract, services and personnel.

3. Identify the contractor’s overall technical/management strengths and weaknesses:

4. Would you have concerns working with this firm again?

|_| Yes |_| No

If yes, please explain:

5. Additional information not included above:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104

WHEN COMPLETED, FOR OFFICIAL USE ONLY