Past_Performance_Questionnaire.docx

Attachment 1

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

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

PAST PERFORMANCE QUESTIONNAIRE

Please complete this Questionnaire and email it to:

Linda M. Williams linda_williams@ao.uscourts.gov Responses Due:

On or before 2:00 pm Eastern Time on June 28, 2019

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

1. CONTRACTOR NAME & ADDRESS:

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:

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 3, 9 and 10.

· You are being asked to rate the identified contractor’s performance within the past 10 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 10 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:

11. RATING SCALE FOR CONTRACT PERFORMANCE:

Outstanding: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

Name of Contractor Being Rated: Contract Number:

Part 3. PAST PERFORMANCE RATINGS (TO BE COMPLETED BY RESPONDENT) Note – When completed, this questionnaire will contain source selection information that should be protected in accordance with Guide to Judiciary Policy Vol. 14 §150.20

Question 1. Cost Control – Assess the contractor’s ability to manage the contract budget and control cost.

Comments:

Questions 2. Quality of Work – Assess the contractor’s conformance to contract requirements, specifications, and terms and conditions. (e.g., design solutions, project management and engineering expertise).

Comments:

Question 3. Compliance with Performance Schedule – Assess the contractor’s performance in regard to adherence to the contract requirements, ability to resolve problems in a timely manner and ability to retain qualified personnel t provide support.

Comments:

Question 4. Responsiveness – Assess the contractor’s responsiveness to customer concerns.

Comments:

Question 5. Ability to Manage Subcontractors – Assess the Contractor’s ability to manage subcontractors in the area of quality work, timeliness of deliverables and overall customer satisfaction.

Comments:

Overall Customer Satisfaction

Other Information Sources. Are you aware of other relevant past efforts by this company? If yes, please provide the name and telephone number of a point of contact:

SOURCE SELECTION INFORMATION – See Guide to Judiciary Policy Vol. 14 §150.20