SWHARC16R0004_-_Appendix_C_-_Past_Performance_Questionnaire.docx

SWHARC16R0004 – APPENDIX C – 16 FEB 2016

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104

WHEN COMPLETED, FOR OFFICIAL USE ONLY

APPENDIX C

PAST PERFORMANCE QUESTIONNAIRE

Offeror Instructions: Complete Transmittal Letter and Section 1 of the Past Performance Questionnaire (PPQ) and send to the assessor(s).

Assessor Instructions: Confirm accuracy and completeness of Section 1 of the PPQ. Complete Section 2 of the PPQ and submit Sections 1 and 2 directly to the Contract Specialist. Do not forward a copy of the completed questionnaire to the vendor whose performance you are evaluating.

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’s solicitation number SWHARC16R0004 for the INL Mexico SETEC IT and Communications Infrastructure 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 team member) 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 must be emailed to FernandezJM@state.gov.

4. If you have any questions regarding the questionnaire, you may contact Juan M. Fernandez of the US Department of State at (305) 718-4291 or via email at FernandezJM@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 Number SWHARC16R0004 (INL Mexico SETEC IT and Communications Infrastructure Project) as part of <insert name of prime offeror> proposal.

1. Company Information: Include name, address, and cage code of company (prime or major subcontractor) for which this reference is provided.

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. PCO

2. ACO

3. COR / CORT

4. 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. If multiple locations, please indicate annual dollar value and full time equivalents (FTEs) per location.

13. Scope of work

a. Describe work performed by your company:

b. Relevancy: Provide information that demonstrates why this reference 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, Office of Acquisition Management. 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 (both Section 1 and Section 2) to FernandezJM@state.gov. You may contact Juan M. Fernandez at FernandezJM@state.gov or (305) 718-4291 should you have any questions.

DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO THE OFFEROR. The information contained in the completed Past Performance Questionnaire is considered Source Selection Information (See FAR 2.101 and FAR 3.104) and may not be released to the Offeror.

EVALUATED BY:

I, the undersigned, being familiar with the work and the performing organization I’m providing information about, have responded to the best of my knowledge and belief. I understand that a representative of the Department of State may contact me for confirmation of my responses to this PPQ. I am authorized by my organization to complete this evaluation.

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

If no, please explain / correct:

2. Performance Evaluation

Assign a rating to each area based on the ratings guidelines below. Please provide a narrative explanation for any rating of marginal or less.

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 and reports.

b. Schedule:

Rating (Acceptable / Unacceptable) Explanation

1. Contractor provided delivered products 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 and minimal corrections were required.

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.

e. Management

(Acceptable / Unacceptable) Explanation

1. Contractor effectively integrated and coordinated all activities required to successfully complete the contract.

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

3. Contractor effectively managed all subcontractors.

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

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

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

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