Attachment_3_Past_Performance_Questionnaire.docx

For Official Use Only

When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire

The Guam National Guard is in the process of competitively selecting a source for Dental Services. The Governments intent is to establish a single Indefinite Delivery Indefinite Quantity (IDIQ) contract for these services.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

The questionnaire may be filled out electronically and e-mailed to ng.gu.guarng.mbx.contracting@mail.mil or by hand.

Please call (671) 735-4625/22 if you have any questions. Your completed questionnaire will become a part of the official Source Selection records. Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Past Performance Questionnaire

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Description of work performed:

J. Was this a competitively awarded contract? ☐ Yes ☐ No

K. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

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: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone number / fax number / e-mail address:

D. Respondent’s position (e.g., Program Manager, PCO/ACO, etc.):

E. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

F. Other suggested points of contact:

Section 4: Performance Information In the questions below, indicate your rating for the contractor’s performance by checking the appropriate box under each question. Provide supporting information for each response in the space provided. Attach additional pages if more space is needed. The performance rating scale is defined as follows:

P Performance Rating

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains 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 being assessed 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.

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

N/A NOT APPLICABLE – Unable to provide a rating. Contract did not include performance for this aspect, performance was not observed, or information was not available. Do not know. UNoteU: The following are SAMPLE questions. Past Performance evaluation teams MUST construct a simple and concise Past Performance Questionnaire, tailored to seek out key information tied to the significant aspects of the planned acquisition. Avoid questions that can be answered with a “yes” or “no” but instead include probing and direct questions to draw out the required information desired.