Attachment_3_PP_Questionaire_6_Jan_2016.pdf

Attachment X Page 1 of 4

PAST PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

PART I – CONTRACT ADMINISTRATION (To be completed by the offeror)

Contract Number: Order: (If applicable)

Contract Award Date: Forecasted or Actual Completion Date:

Contractor/Company Name & Division:

Contractor Address:

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

Prime Contractor POC:

Name:

Telephone No:

E-mail:

Contracting Organization & Address:

Telephone No:

Contracting Officer:

Telephone No:

E-mail:

Contract Administrator:

Telephone No:

Customer Name and Address

Customer POC:

Program Identification / Title:

Briefly describe the nature of the contractual effort:

What was the period of performance of this contract? Please include the $ value for each period.

Period of Performance Period 1 date:

Period 2 date:

Period 3 date:

Period 4 date:

Period 5 date:

Obligated Value

Ceiling

Acquisition Method: Competitive Yes No

Contract Type: FFP ; T&M ; LH ;

Cost type ; Other FP type

Identification Of Offeror’s Representative:

Name:

Title:

Date:

W58RGZ-15-R-XXXX Attachment X Please provide your candid response to the following questions. The information that you provide will be used in the potential award of a federal contract. Therefore, it is important that your information be as factual and accurate as possible to preclude the need for follow-up by the evaluators. If you do not have the appropriate knowledge of, or experience with the company in question, please forward this questionnaire to the person who does. If you need more space, attach additional page(s). Please return the completed questionnaire to the Contracting Officer within three days. If any response herein is negative, please indicate whether the contractor was previously informed as such and provide a copy of his response, if applicable. .Thank-you.

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

Provide responses to the questions below using the following adjectival ratings:

Unacceptable Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

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.

Acceptable Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

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.

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.

A. 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) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

B. Effectiveness of Project Management.

Outstanding (Explanation must be provided in Comments field below) Good Acceptable Marginal (Explanation must be provided in Comments field below) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

Subcontractor Control.

Did the contractor use subcontractor(s) in the performance of any portion of this contract?

No Yes If yes, complete the following:

1. What did the subcontractor(s) do?

2. How well did the prime manage the subcontractor(s)?

3. Was the contractor timely in awarding subcontracts? Indicate timeliness of subcontract awards and management of subcontracts.

4. Did any problem occur with the subcontractor(s)?

5. If a large business, did the contractor meet or exceed the goals contained in an approved subcontracting plan during the course of the contract performance? No Yes

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C. Timeliness of Performance for Services and Product Deliverables.

Outstanding (Explanation must be provided in Comments field below) Good Acceptable Marginal (Explanation must be provided in Comments field below) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

Outstanding (Explanation must be provided in Comments field below) Good Acceptable Marginal (Explanation must be provided in Comments field below) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest Outstanding (Explanation must be provided in Comments field below) Good Acceptable Marginal (Explanation must be provided in Comments field below) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

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

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

No Yes Are you aware of other relevant past efforts by this company?

If yes, please provide the point of contact information:

Name:

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

Thank you for your assistance.