Past_Performance_Questionnaire.pdf

ATTACHMENT 5

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _______________________________________________________________________________

B. Cage Code: _________________________________

C. Contract number: _______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

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

J. Description of service provided: ______________________________________________________________

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

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

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number:

D. Number of years 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. This scale is defined as follows:

CODE PERFORMANCE LEVEL

S SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performances contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

US UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

NA NOT APPLICABLE - Unable to provide a score.

Technical Performance S M US NA

Quality of operations & maintenance.

Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

Adequacy/effectiveness of environmental safety procedures

Program Management S M US NA

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

Understand/complied with customer objectives and technical requirements

Successfully responded to emergency and/or surge situations

Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Employee Retention/Attraction S M US NA

Ability to hire/apply a qualified workforce to this effort.

Ability to retain a qualified workforce on this effort.

Cost Performance S M US NA

Ability to meet forecasted costs and perform within contract costs

Ability to alert Government of unforeseen costs before they occur

Sufficiency and timeliness of cost reporting

1. Please discuss each and every response for which you indicated M (Marginal) or US (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

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

Yes____ No____ Default____ Convenience____ Pending Terminations____

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

SECTION 5: NARRATIVE SUMMARY

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:

Mailing Address:

Or FAX/E-mail to:

Steve Talbott

MICC-JBLM

Building 2015, Room 216

MS-19, Box 339500 JBLM, WA 98433-9500

Commercial: (253)966-3499, DSN: 347-3499

Fax: (253)967-2772

Email: micc.list.proposals@mail.mil mailto:micc.list.proposals@mail.mil