Performance_Risk_Assessment_Questionnaire.pdf

CONTRACTOR PERFORMANCE REPORT

PAST PERFORMANCE INFORMATION- FOR OFFICAL USE ONLY

PART I – GENERAL CONTRACT DATA

1. Type of report

[ ] Annual [ ] Interim

[ ] Final [ ]

Termination

2. Contractor

3. Date:

4. Contract No.

5. Description of Requirement:

6. Contract Period(s):

Base __________ to __________

Option I __ __ to __________

Option II __________ to __________

Option III __________ to __________

Option IV __________ to __________

7. Contract Value:

Base $ ______________

Option $ ______________

Option II $ ______________

Option III $ ______________

Option IV $ ______________

8. Type of Contract:

[ x ] FFP [ ] CPFF [ ] T&M [ ] IDIQ [ ] Other (Specify) :

PART II – RATING (See continuation sheet for rating instructions)

9. Performance Elements 0 1 2 3 4 5 Totals

A. Quality of Service

B. Timeliness of Performance

C. Customer Service

D. Cost Control

Overall Total

10. Comments: (If rated 0 to 1 in any element, comments are required).

11. Recommendations: (If no explain in space provided in this block)

Future Contract Awards? [ ] Yes [ ] No Contract Renewal? [ ] Yes [ ] No

12. Name/Title/Organization of Rating

Official

15. Name/Title of Reviewing Official

13. Signature 14. Date 16. Signature 17. Date

PART III – CONTRACTOR REVIEW

Where comments, correspondence, or any additional information provided to you during contract performance?

[ ] Yes [ ] No . Please attach any comments and submit, within 30 calendar days after receipt, to the

Reviewing Official shown in Block # 15.

18. Name and Title of Contractor’s Official 19. Signature 20. Date

INSTRUCTIONS FOR COMPLETION OF PART II RATING

A. Summarize the Contractor’s performance on each of the PERFORMANCE ELEMENTS listed in

Block # 9 by assigning a rating of:

0–Unsatisfactory, 1–Poor, 2–Fair, 3–Good, 4–Excellent, 5–Exemplary

B. In order to ensure consistency among rating officials, the following Rating Tables should be used as guidance in making these evaluations

RATING TABLES

Rating A. Quality of

Services

B. Timeliness of

Performance

C. Customer

Service

D. Cost

Control

0–Unsatisfactory Non-conformance compromising achievement of contract performance.

Delays and/or tardiness are compromising achievement of contract performance despite Agency efforts to correct problems.

Responses to inquires of technical services, and administrative issues are not effective and or responsive.

Cost issues compromising achievement of contract performance.

1-Poor Non-conformance requires significant

Agency resources to ensure satisfactory contract performance.

Delays require significant

Agency resources to ensure satisfactory contract performance.

Responses to inquiries of technical services and administrative issues marginally effective and or responsive.

require significant

Agency resources to ensure satisfactory contract performance.

2-Fair Non- conformance requires minor

Agency resources to ensure satisfactory contract performance.

Delays and or tardiness require minor Agency resources to ensure satisfactory contract performance.

Responses to inquiries of technical services and administrative issues somewhat effective and or require minor Agency resources to ensure satisfactory contract performance.

3-Good Non-conformance does not impact on satisfactory contract performance.

Delays and or tardiness do not have an impact on satisfactory contract performance.

Responses to inquiries of technical services and administrative issues usually effective and or responsive.

Cost issues do not have an impact on satisfactory contract performance.

4-Excellent There are no quality and or safety problems.

There are no delays and or tardiness in performance of services.

Responses to inquiries of technical services and administrative issues effective and or

There are no contract cost issues.

5-Exemplary Contractor has demonstrated exceptional performance level.

Contractor has demonstrated exceptional performance level.

Contractor has demonstrated exceptional performance level.

Contractor has demonstrated excellent cost containment and has identified areas of potential cost savings to agency.