Attachment_E_Past_Performance_Evaluation_Questionnaire_Form_061318.pdf

ATTACHMENT E - PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

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

PAST PERFORMANCE QUESTIONNAIRE

Please complete this Questionnaire and email it to:

Tricia Butler, Contract Specialist

Patricia_Butler@ao.uscourts.gov

Responses Due:

On or before 10:00 am Eastern Time on

August 1, 2018

Instructions

• Appendix C, 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 quote (by the closing date of the Request for Quote (RFQ) copies of Section I and Appendix C, Part 1that was provided to all respondents.

• Appendix C, Part 1b to be validated by the respondent. Respondent, if any information is incorrect herein, please annotate and provide the correct information.

• Appendix C, 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 mailto:patricia_butler@ao.uscourts.gov

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 Task Order/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.

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:

Name of Contractor Being Rated: Contract Number:

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 1a. What is your overall assessment of the quality of the contractor’s performance?

Factor Outstanding* Good Acceptable Marginal* Unacceptable* Quality of Performance

* All comments are appreciated; however, at a minimum, rationale must be provided for ratings of outstanding, marginal or unacceptable.

Comments:

Question 1b. Assess the contractor’s quality of performance in the following areas:

Factor Outstanding* Good Acceptable Marginal* Unacceptable* Conformance to contract requirements

Standards of Workmanship:

technical, professional

Question 2a. What is your overall assessment of the contractor’s ability to meet the schedule?

Factor Outstanding* Good Acceptable Marginal* Unacceptable* Schedule Performance

** All comments are appreciated; however, at a minimum, rationale must be provided for

Question 2b. Assess the contractor’s schedule performance in the following areas:

Factor Outstanding

Good Acceptable Marginal* Unacceptable*

Completion of contract Schedule

Meeting Milestones and Schedules

Submitting Deliverables

Question 3a. What is your overall assessment of the contractor’s management oversight?

Management Responsivenes s – timeliness, completeness, quality of problem identification, effective business relations and customer satisfaction

Program Management – effectiveness of integration and coordination of all activities required to execute the contract, use of resources;

and, assignment of responsibility.

** * All comments are appreciated; however, at a minimum, rationale must be provided for

Question 3b Assess the contractor’s quality of performance in the following areas:

Management Responsiveness

Program Management

Question 4. Overall rating of contractor’s performance (Quality of Performance, Schedule Performance, Management Oversight and Cost Control) on contract being assessed.

Outstanding* Good Acceptable Marginal* Unacceptable*

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:

Intentionally Left Blank

NAME OF RESPONDENT

(Type or print)

SIGNATURE OF RESPONDENT DATE SIGNED

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

Name of Contractor Being Rated: Contract Number: