L6_PastPerformance_Questionnaire.pdf

Appendix D – Past Performance Questionnaire

DEPARTMENT OF THE ARMY

COMMAND/ACTIVITY LETTERHEAD

TBD

U.S. Army Contracting Command Orlando (ACC-Orlando) 12211 Science Drive Orlando, FL 32826

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number W900KK-18-R-

0010 for the One Semi-Automated Forces acquisition

Dear Sir/Ma’am;

The US Army Contracting Command – Orlando with the Program Executive Office for Simulation, Training and Instrumentation (PEO STRI) is currently conducting a competitive source selection to evaluate offerors on subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state or local government or commercial contracts as compared to North American Industry Classification System (NAICS) 541512. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation. Please complete the enclosure and return to the U.S. Army Contracting Command-Orlando, ATTN: David Hagler, Contract Specialist, ACC-ORL-OPC, 12211 Science Drive, Orlando FL 32826-3224 no later than 15 days after receipt of request or TBD, whichever occurs first. Your questionnaire may be submitted electronically to David Hagler, Contract Specialist, david.a.hagler.civ@mail.mil or Mr. Dunamis Triska, Contracting Officer, dunamis.t.triska.civ@mail.mil.

Your cooperation is greatly appreciated. Questions may be directed to the Contract Specialist at (407) 208- 3164 or the Contracting Officer at (407) 208-5862.

Sincerely, DUNAMIS T. TRISKA

Contracting Officer

Enclosure

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: ____________________ Contract No.:____________________________

Subcontract No. (If applicable):_________________________________

POC: ________________________ Title: ________________________

(Name) (E.G. PCO/ACO/TM)

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past five years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible.

Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

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.

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.

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

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.

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

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

E-mail Address:

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

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 (to include use and control of subcontractors).

Acceptable

C. Timeliness of Performance for Services and Product Deliverables.

Acceptable

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost

Reimbursement Type Contracts Only).

Acceptable

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Acceptable

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

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

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:

H. Respondent Identification. Please provide the following information:

Organization:

Title:

Date:

Telephone Number

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.

Signature Date

Typed or Printed Name

TELEPHONE INTERVIEW QUESTIONNAIRE FORM

Contractor: ____________________ Contract No.:____________________________

Subcontract No. (If applicable):_________________________________

POC: ________________________ Title: ________________________

(Name) (E.G. PCO/ACO/TM)

(Agency, Telephone No., E-mail & Facsimile No.)

If conducting a telephone interview:

“Hello, I am ______________________. I am calling in reference to Contract

____________________ with a company called ________________________. My questions will pertain to the contractor’s record of past, which is defined as within the past five years and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible.

A summary of this discussion may be sent to you for your records. The following adjectival ratings shall be used in your response.

The following questions pertain to the contractor’s record of past (within the past five years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible.

Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Title:

Date:

Telephone Number:

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

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification

Requirements and Standards of Good Workmanship

Acceptable

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

Acceptable

C. Timeliness of Performance for Services and Product Deliverables.

Acceptable

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost

Reimbursement Type Contracts Only).

Acceptable

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Acceptable

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

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

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:

H. Respondent Identification. Please provide the following information:

Organization:

Title:

Date:

Telephone Number

Record of Interview: (to be filled out by PPT member)

( ) Discussed recentness and relevance of information

( ) Read summary to person contacted Date: ____________________

( ) Sent copy to person contacted Date: ____________________

PPT Member Signature Typed or Printed Name

Telephone Fax

TELEPHONE INTERVIEW REPORT FORWARDING MEMORANDUM

Contracting Office

MEMORANDUM FOR

SUBJECT: Telephone Interview Report

1. Enclosed is a summary of your telephone conversation, (date), with a member of a Past

Performance Team at this Command.

2. It is requested that you review and verify the accuracy of this report and e-mail or fax it to us by (date). It is extremely important that you respond by this date so Army readiness will not be compromised. If we do not hear from you by the day indicated above, we will consider the summary of the discussion official.

3. We would like to thank you in advance for your time and assistance regarding this acquisition.

If you have any questions or comments, you may address them to the Contract Specialist at

(407) 384-5100 or fax to (407) 384-3066.

CONTRACTING OFFICER

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