Past_Perfromance_Questionnaire_-_Word.doc

Past Performance Assessment Questionnaire

Please provide your candid response to the following questions. 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 it by electronic e-mail to Roxanne Dunn at roxanne.L.dunn.civ@mail.mil by July 14, 2017. Thank you for your assistance.

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

A. RELEVANT CONTRACT

Prime Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract/Task Order Number:

Contract Award Date:

Contract Period of Performance End Date:

Forecasted or Actual Contract Completion:

B. OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone 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 Exhibit Design:

Assess the quality and workmanship of the contractor’s museum exhibit design (e.g., {insert any specific things you want to consider when they provide the rating here).

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 and/or if other factors beyond the control and without the fault or negligence of the contractor played a predominant role.

2. Project Schedule:

Assess the timeliness of contractor performance (e.g. design reviews, etc) 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 and/or if other factors beyond the control and without the fault or negligence of the contractor played a predominant role.

3. Management / Business Relations:

Assess the efforts of contractor’s management and business relations during the performance of the effort. (i.e. timely identification of deficiencies, effective and timely corrective action plans, ability to provide sufficient contractor staffing, etc.)

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 and/or if other factors beyond the control and without the fault or negligence of the contractor played a predominant role.

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:

Address:

Name:

Title:

Date:

Telephone Number:

E-mail Address:

Once Filled In, this document is considered

Source Selection Information – See FAR 2.101 and FAR 3.104