Attachment A-Past Performance Questionnaire_FINAL.pdf

W911SR-21-R-0002

ATTACHMENT A

Performance Risk Assessment Questionnaire

The information provided in this questionnaire will be used during the evaluation for a federal Government contract. Information should be factual, accurate, and complete to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this questionnaire to the person who does. Return the completed questionnaire within 3 days.

The following are definitions of the adjectival ratings noted in each section below:

Exceptional: 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.

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

Unsatisfactory: 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:

Total Contract Value:

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:

Address:

E-mail Address:

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

Exceptional (Explanation must be provided in Comments field below) Satisfactory Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

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

B. Effectiveness of Project

C. Timeliness of Performance for Services and Product Deliverables, including the Administrative Aspects of Performance.

D. Effectiveness in Forecasting and Controlling Project Cost.

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

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:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

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

F. Overall Satisfaction.