Atch_003.pdf

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 performance 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.

Workmanship Performance S M US NA

W1. Quality & repeatability of operations & maintenance.

W2. Quality of technical system testing and certification efforts

W3. Quality/integrity of technical data/report preparation efforts

W4. Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

W5. Ability to implement current standard practices for computer hardware design, operation, maintenance, upgrades and configuration control

W6. Ability to implement current standard practices for computer software design, operation, maintenance, upgrades and configuration control

W7. Adequacy/effectiveness of environmental safety procedures

Timeliness of Performance S M US NA

T1. Timeliness/effectiveness of contract problem resolution without extensive customer guidance.

T2. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

T3. Projects were delivered on time as stipulated in the contract.

T4. Contractor notifications to customers are timely in regards to problems/concerns that are encountered during performance.

Business Relations S M US NA

B1. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

B2. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

B3. Understand/complied with customer objectives and technical requirements

B4. Successfully responded to emergency and/or surge situations

B5. Quality/effectiveness of sub-contracted efforts

B6. Effectiveness of material management (including Government Furnished Property or Material)

B7. Effectiveness of acquisition management

B8. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

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____ Default____ Convenience____ Pending Terminations____ No ____

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: