W911QY-19-D-0003_ETSSLS_Attachment_0011_Past_Performance_Questionnaire.pdf

ATTACHMENT 0011: PAST PERFORMANCE ASSESSMENT QUESTIONNAIRE

THIS DOCUMENT JS SOURCE SELECTION SENSITIVE INFORMATION

JAW FAR 3.104 (whenfilledin)

SECTION 1: CONTRACT IDENTIFICATION

Contractor:

CAGE Code (of contractor contract was awarded to) :

Contract Number:

Contract Type:

Competitive Contract?

Period of Performance:

Initial Contract Cost:

Current/Final Contract Cost:

Reasons for differences between initial contract cost and final contract costs:

Description of service provided:

SECTION 2. CUSTOMER OR AGENCY IDENTIFICATION

Customer/ Agency Name:

Customer/Agency Description (if applicable):

Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

SECTION 3. EVALUATOR IDENTIFICATION

Evaluator's Name:

Evaluator's Title:

Evaluator's Phone/FAX Number:

Number of years the evaluator worked on subject contract:

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor's performance by placing an X in the appropriate block using the scale provided to the right of each question. The performance scale is defined as follows:

PERFORMANCE LEVEL LEGEND

B = BLUE/EXCEPTIONAL: The contractor's performance meets contractual requirements and exceeds many

(requirements) to the Government's benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

If yes, please explain (i.e. inability to meet cost, performance, or delivery schedules, etc.):

SECTION 5: NARRATIVE SUMMARY

What were the contractor's most positive aspects in the performance of the contract?

What were the contractor's most negative aspect in the performance of the contract?

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor's performance, as desired.

Evaluator's Signature

Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Schon Zwakman, schon.m.zwakman.civ@mail.mil

The Subject Line of the email shall be:

ETSSLS - W911QY19R0003 - (Offeror's Company Name)