U09 MATOC EXHIBIT B - PAST PERFORMANCE QUESTIONNAIRE.docx

Solicitation W50S7L-25-R-A003

EXHIBIT B

PAST PERFORMANCE QUESTIONNAIRE

Instructions to Offeror for sending Questionnaires:

The Past Performance Questionnaire should be submitted to the owners of any of the projects listed in Factor 1 of the proposal for which there are no Contractor Performance Assessment Reporting System (CPARS) evaluations.

For Government contracts, send to the Contracting Officer or Contracting Officer’s Representative. For commercial references, send a questionnaire to personnel with duties similar to those for Government contracts.

Offerors should follow up and encourage references to return the completed questionnaires in a timely manner. If you have multiple references at one location (i.e. at a military base), send one cover letter and questionnaires for each contract for which you need a reference. Your questionnaire package should contain the following:

· Cover Letter (See SAMPLE on the next page)

· Respondent Info Rating Sheets (the following 4 pages). Offeror should put name in spaces indicated and ensure it is on every page for identification purposes.

OFFEROR SHOULD PLACE THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE

In accordance with SECTION 00 22 16, PROPOSAL EVALUATIONS AND BASIS FOR AWARD, the completed questionnaires should be sent directly to the Contracting Office.

OFFEROR SHOULD DELETE THIS INSTRUCTION PAGE BEFORE SENDING OUT QUESTIONNAIRES.

SAMPLE TRANSMITTAL LETTER AND PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Your Company Letterhead

Date:

To:

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm will be submitting a proposal under a project advertised by the Montana National Guard (MTNG). In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance. Your candid response to the attached questionnaire(s) will assist the government evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible for each contract we have performed. Space is provided for comments. Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306(e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each firm is required.

Please return your completed questionnaire electronically to the following email address: Adam.d.sackman.civ@army.mil

If questionnaires are not sent electronically, please return them to the physical address below:

ATTN: Adam Sackman (P&C) USPFO for MT- Purchasing and Contracting Helena Armed Forces Reserve Center (HAFRC)- Rm 589B 1956 Mt. Majo St, Fort Harrison, MT 59636-4789

This documentation must arrive NOT LATER THAN [Contractor to enter date] so that it can be evaluated with our proposal.

If you have questions regarding the attached questionnaire or require assistance, please contact the Contract Specialist at adam.d.sackman.civ@army.mil (406) 324-3407 or the Contracting Officer at jodi.l.zolynski.civ@army.mil (406) 324-3405. Thank you for your assistance.

Signature and Title

Montana National Guard PAST PERFORMANCE QUESTIONNAIRE (Exhibit B)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Phone Number: Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Subcontractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify): Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy): Actual Completion Date (mm/dd/yy): Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: The MTNG requests the Client completes this questionnaire and submits directly to Mr. Adam Sackman at adam.d.sackman.civ@army.mil AND Ms. Jodi Zolynski at jodi.l.zolynski.civ@army.mil. The Government reserves the right to verify all information on this form.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

(U) Unsatisfactory

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

b) Ability to meet quality standards specified for technical performance

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

3. CUSTOMER SATISFACTION:

4. MANAGEMENT/ PERSONNEL/LABOR

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

E VG S M U N

5. COST/FINANCIAL MANAGEMENT

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG S M U N

c) If this is/was a government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

E VG S M U N

e) If this is/was a government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the user’s rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E VG S M U N

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):