Attachment_0004-_Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

Source Selection Information --See FAR 2.101 and 3.104 1

Past Performance Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please return the completed Questionnaire within 30 days after release of RFP. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact Respondent)

Exceeds Contractual Requirements (Explanation must be provided in Comments field below) Meets Contractual Requirements Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

Comments:

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

Source Selection Information --See FAR 2.101 and 3.104 2

Exceptional (Explanation must be provided in Comments field below) Satisfactory Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

Exceeds Contractual Requirements (Explanation must be provided in Comments field below) Meets Contractual Requirements Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

Comments:

Exceptional (Explanation must be provided in Comments field below) Satisfactory Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

Exceptional (Explanation must be provided in Comments field below) Satisfactory Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

F. Overall Satisfaction

Extremely Satisfactory (Explanation must be provided in Comments field below) Satisfactory Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

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

C. Timeliness of Performance for Product Deliverables, including the Administrative Aspects of Performance.

D. Effectiveness in Forecasting and Controlling Project Cost.

F. Overall Satisfaction.

G. General Comments. Provide any other relevant performance information.

E. Commitment to Customer Satisfaction and Business-

Source Selection Information --See FAR 2.101 and 3.104 3

Comments:

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:

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contracting Officer identified in the cover letter.

Thank you for your assistance.

H. Other Information Sources. Please provide the following information:

I. Respondent Identification. Please provide the following information: