J-6_Past_Performance_Questionaire.docx

J-6 PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Administrative Office of the U.S. Courts (AOUSC)

PAST PERFORMANCE QUESTIONNAIRE

Please complete this Questionnaire and email it to:

Donald Parkins, Contracting Officer Don_Parkins@ao.uscourts.gov Responses Due:

On or before 2:00 pm Eastern Time on

Instructions

· Attachment J-6, Part 1a and 1b to be completed by the Offeror (vendor) and provided to the respondent (Government personnel who had experience with the Offeror on a previous relevant contract.) The respondent, in turn, verifies Sections I through III, complete the questionnaire, and submit directly to the Contracting Office. The Offeror should also submit with its proposal (by the closing date of the Request for Proposal (RFP) copies of Section I and Attachment J-6, Part 1that was provided to all respondents.

· Attachment J-6, Part 1b to be validated by the respondent. Respondent, if any information is incorrect herein, please annotate and provide the correct information.

· Attachment J-6, Parts 2 and 3 to be completed in their entirety by the respondent.

Message to the Respondent: Your assistance is requested by the Administrative Office of the U.S. Courts (AOUSC) to assist with establishing the performance history for the Contractor named below. In efforts to expedite receipt of the requested information, the Contracting Officer respectfully requests that you do not mail hard copies. Instead, please email the completed questionnaire(s) to: patricia_butler@ao.uscourts.gov.

Part 1a. TO BE COMPLETED BY OFFEROR - Solicitation Data (for the proposed effort)

RFP/Solicitation No.

Project/Requirement Name/Title

Customer/Agency

Project/Requirement Description

Part 1b. TO BE COMPLETED BY OFFEROR – Information about Past Contract

1. CONTRACTOR/SUBCONTRACTOR NAME, ADDRESS, PLACE OF PERFORMANCE, & DUNS NUMBER (If the work was performed as a subcontractor, also provide the name of the prime contractor and Point of Contact (POC) within the prime contractor organization (name, and current address, e-mail address, and telephone number) who can verify the participation and extent of work performed by the offeror):

2. CONTRACT NO.:

3. CONTRACT PERIOD OF PERFORMANCE:

4. CONTRACT VALUE (with options):

5. CONTRACTING OFFICER’S NAME

6. CONTRACTING OFFICER’S EMAIL ADDRESS & PHONE NUMBER

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

7. DESCRIPTION OF CONTRACT REQUIREMENTS (continued):

8. Government contracting activity/commercial activity for which work was performed, with current address, email address, telephone number of the procuring contracting officer or customer point of contact.

9. Name of government’s technical representative/COR, with current address, email address, and telephone number.

10. Government contract administration activity, with the name, current address, email-address and telephone number of the Administrative Contracting Officer’s (if different than the POC provided under 8 above.

11. Contract Number (including, in the case of projects performed under orders against Indefinite Delivery type contracts, GSA contracts, and Blanket Purchase Agreements, relevant BPA Call Numbers.

12. Contract Type (specific type such as Fixed-Price (FP), Cost Reimbursement (CR), Time & Material (T&M), Labor Hour (LH) etc.). In the case of Indefinite Delivery contracts, also indicate specific type (i.e., Requirements, Definite Quantity, and Indefinite Quantity).

13. Awarded price/cost. (If the offeror, or its proposed major subcontractor, was responsible for only a portion of the tasks performed under the referenced contract, then the total price/cost should only include the price/cost of work performed by the offeror or its proposed major subcontractor.)

14. Final (or, if work is ongoing, projected final) price/cost. (If the offeror, or its proposed major subcontractor, was responsible for only a portion of the tasks performed under the referenced contract, then the final price/cost should only include price/cost paid or to be paid for work performed by the offeror or its proposed major subcontractor.)

15. Final (or, if work is ongoing, projected final) delivery schedule, including dates of start and completion of work. If the final delivery schedule was adjusted due to delays caused by the offeror, provide information about and reason for such delay.

Administrative Office of the U.S. Courts (AOUSC)

PAST PERFORMANCE QUESTIONNAIRE

Name of Contractor Being Rated: Contract Number:

Part 2. TO BE COMPLETED BY RESPONDENT

· Please provide information about yourself in blocks 8, 9 and 10.

· You are being asked to rate the identified contractor’s performance within the past three years under the contract referenced above. The information that you provide will be considered during the Proposal evaluation process for award of a federal contract. Therefore, it is important that the information be factual and as accurate as possible. Please use the rating scale in block 11 to answer questions 1 through 4 below about the contractor's performance under the referenced contract during the past three years.

· In addition, you are encouraged to provide examples and/or explanations (use additional pages if necessary) to support adjectival ratings given.

8. EVALUATOR'S NAME, POSITION (CO/Project Manager/ COR/ Other) AND ORGANIZATION:

9. EVALUATOR'S PHONE NUMBER AND E-MAIL ADDRESS:

10. MONTHS PERFORMANCE MONITORED BY EVALUATOR: