USCA20R0002_-Attachment_2_-_Past_Performance_Questionnaire.doc

Attachment 2 - Past Performance Questionnaire

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

Chapter 13 Standing Trustee Audits

PERFORMANCE QUESTIONNAIRE

Please complete this Questionnaire and mail or email it to:

Kimeerly Fleming, Contracting Officer

Administrative Office of the United States Courts

One Columbus Circle, NE, Suite 3-250

Washington, DC 20544 Kimeerly_Fleming@ao.uscourts.gov

Responses Due: 9:00 am ET on Wednesday, October 30, 2019

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION and shall be protected accordingly. See Guide, Vol. 14, § 130.20.35 Procurement Integrity Act.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

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

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

d. CONTRACTING OFFICER’S NAME e. CONTRACTING OFFICER’S PHONE NUMBER

Please circle the response code for each rated topic that best reflects your experience with this contractor. Rationale must be provided for ratings of outstanding, marginal or unacceptable.

0 = Unacceptable 3 = Good 1 = Marginal 4 = Outstanding 2 = Acceptable N/O = Not Observed

Attachment 2 - Past Performance Questionnaire Administrative Office of the U.S. Courts (AOUSC)

Chapter 13 Standing Trustee Audits

PERFORMANCE QUESTIONNAIRE – page 2

A. What is your assessment of the quality of the contractor’s performance including conformance to contract requirement and standards of workmanship technical and professional?

N/O Comments: ____________________________________________________________________________________________________________________

B. What is your assessment of the contractor’s ability to meet the schedule including completion of contract schedule, meeting milestones and submitting deliverables?

N/O

Comments: ____________________________________________________________________________________________________________________

C. What is your assessment of the contractor’s management oversight including management responsiveness (timeliness, completeness, quality of problem identification, effective business relations and customer satisfaction) and program management (effectiveness of integration and coordination of all activities required to execute the contract, use of resources; and, assignment of responsibility)

N/O

Comments: ____________________________________________________________________________________________________________________

D. What is your overall assessment of the contractor’s performance?

N/O

Comments: ____________________________________________________________________________________________________________________

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:

NAME OF RESPONDENT (Type or print)

SIGNATURE OF RESPONDENT

DATE SIGNED