Attachment_0010_-_Past_Performance_Questionnaire.docx

DEPARTMENT OF THE ARMY

UNITED STATES ARMY CONTRACTING COMMAND-WARREN

6501 EAST 11 MILE ROAD

WARREN, MICHIGAN 48397-5000

Past Performance Assessment Questionnaire Please provide your candid response to the following questions IAW the Past Performance Questionnaire Letter. The information that you provide will be used in the awarding of federal contracts. Therefore it is important that your information be as factual and accurate as possible. If you do not have the appropriate knowledge with the company in question, please forward this questionnaire to the person who does. Upon completion of this questionnaire, please forward by electronic email to ATS III mailbox at usarmy.detroit.acc.mbx.wrn-atsiii@mail.mil by TBD. Thank you for your assistance.

PART I - IDENTIFICATION (To be completed by the Offeror)

A. RELEVANT CONTRACT

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract/Task Order Number:

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

Contract Award Date:

Contract Period of Performance End Date:

Forecasted or Actual Contract Completion:

Brief Description of the Relevant Contract Scope:

B. OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

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

RATING SCALE & DEFINITIONS

Table 1 identifies the rating scale and descriptions. Please apply the rating that most closely matches your assessment for each area of consideration listed below. Please include a written narrative for each rating applied, utilizing the adjectival rating definition in Table 1.

Table 1

1. Quality of Design and Construction:

Assess the contractor’s quality of construction, design, and conformance to specification requirements and standards of good workmanship (e.g., technical, professional, environmental, safety, and health standards).

|_| Exceptional |_| Very Good |_| Satisfactory |_| Marginal |_| Unsatisfactory |_| Too soon to tell |_| Not Applicable

Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor.

2. Project Schedule:

Assess the timeliness of contractor performance against completion of key milestones (e.g. design reviews, release for construction) and completion of the overall project. This assessment of the contractor’s adherence to the required performance schedule should include the contractor’s efforts that contributed, negatively or positively, to the project schedule.

|_| Exceptional |_| Very Good |_| Satisfactory |_| Marginal |_| Unsatisfactory |_| Too soon to tell |_| Not Applicable

Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. delays by the customer/end user, changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor (e.g. unusually severe weather or default of a subcontractor beyond the control of both the Contractor and subcontractor).

3. Management / Business Relations:

Assess the efforts of contractor management to verify that control measures are adequate to provide a product which conforms to contract requirements, timely identify any deficiencies or noncompliance with contract requirements, effectively implement corrective action plans to any identified deficiencies or noncompliance with contract requirements, management of subcontracts, and provide sufficient contractor staffing.

|_| Exceptional |_| Very Good |_| Satisfactory |_| Marginal |_| Unsatisfactory |_| Too soon to tell |_| Not Applicable

Comments:

For any adverse issues give your assessment of the extent to which the contractor was at fault (e.g. mostly attributable to contractor, evenly attributable to contractor and customer/end user, only some somewhat attributable to contractor) and your assessment of the extent to which customer/end user was at fault (e.g. changes to the specification requirements, unrealistic or ambiguous specification requirements, etc.) or other factors beyond the control and without the fault or negligence of the contractor.

4. General Comments.

Any additional information, which your organization deems relevant or important, will be welcome by our evaluation team. Please provide any other relevant or important performance information.

Comments:

PART III - RESPONDENT IDENTIFICATION

Please provide a point of contact who compiled or completed this questionnaire and who, if needed, may be contacted by our evaluation team regarding the information provided in this questionnaire.

Organization:

Name:

Title:

Date:

Telephone Number:

Address:

Fax Number:

E-mail Address:

Once Filled In, this document is considered Source Selection Information – See FAR 2.101 and FAR 3.104 image1.png image2.emf image3.png