Past Performance Evaluation Questionnaire - Attachment 1.pdf

W911NF-20-R-0002 - ATTACHMENT 1

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor Contract No.:

Subcontract No. (if applicable):

POC: Title:

(Name)

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

The following questions pertain to the contractor’s record of past (within the past three 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)

Contractor Name/Division:

Contractor Address:

Program 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: Description of the Contractual Effort or Items purchased:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

Part II. Evaluation (To be completed by Point of Contact – Respondent)

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:

Acceptable

A. Contract Identification

B. Identification of Offeror’s Representative

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

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

Acceptable

Acceptable

Acceptable

C. Timeliness of Performance for Services and Product Deliverables.

D. Effectiveness in Forecasting and Controlling Estimated Costs

E. Commitment to Customer Satisfaction and Business-like Concern for its customers’ interest.

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

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail as instructed in the solicitation.

26 February 2020 Signature Date

Leroy R. Hardy Jr.

Typed or Printed Name

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:

Thank you for your assistance.