USCA25R0108 - ATTACHMENT 3 - Past Performance Questionnaire.docx

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

PAST PERFORMANCE QUESTIONNAIRE

USCA25R0108

Please complete this Questionnaire and email it to:

Arianne Downey, Contract Specialist Arianne_Downey@ao.uscourts.gov by no later than 12:00 P.M. Eastern on 06/06/2025.

Questionnaires must be submitted by the respondent. Late questionnaires will not be accepted.

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

3. CONTRACT PERIOD OF PERFORMANCE:

4. CONTRACT VALUE (with options):

5. CUSTOMER POINT OF CONTACT NAME:

6. CUSTOMER EMAIL ADDRESS & PHONE NUMBER

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

USCA25R0108

Attachment 2

USCA25R0108

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:

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.

USCA21Q0096

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. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

· Marginal (Explanation must be provided in Comments field below)

· Unacceptable (Explanation must be provided in Comments field below) Comments:

Questions 2. Effectiveness of Project Management (to include use and control of subcontractors)

· Outstanding (Explanation must be provided in Comments field below)

· Good

· Acceptable

Question 3. Timeliness of Performance for Services and Product Deliverables.

· Good

· Acceptable

Question 4. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

· Good

· Acceptable

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