Past Performance Questionnaire Revised 24 Jan 24.pdf

MICC – Fort Johnson, Louisiana

PAST PERFORMANCE QUESTIONNAIRE

Estimated Reporting Burden Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and maintain the data needed, and completing the collection of information.

INSTRUCTIONS: Offeror shall provide three (3) past performance references this questionnaire.

Each individual reference must complete and submit directly to the MICC office via email per Addenda 52.212-1. ( See Below) Offeror is not to submit this questionnaire on behalf of themselves.

TO: Government agency or commercial organization (i.e., customer) with knowledge on bidder’s past performance.

1. Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you and is interested in doing business with the Mission and Installation Contracting Command (MICC) – Fort Johnson, Louisiana. Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The Offeror identified you as a past performance reference and is authorizing you to release information relative to their past performance, whether it is positive or negative information.

Past Performance information helps the government assess the relative risks associated with an offeror’s likelihood of success in performing the solicitation’s requirements. Consideration is given to the offeror’s record of past performance and its relevancy to the services being procured under this solicitation.

Email the completed questionnaire to the attention of ALL below listed individuals (e.g.

Contracting Officer, Contract Specialist(s)), which will help ensure receipt of the questionnaire.

Identified below is the solicitation number, name, and email address for the POCs. Your completed questionnaire must be provided directly to the MICC – Fort Johnson from you.

MICC – Fort Johnson will not accept completed questionnaires sent from the offeror.

It is important that the questionnaire be completed and provided to the MICC – Fort Johnson, no later than the solicitation CLOSING date, as stated below.

a. Solicitation:

b. Closing Date for Solicitation:

c. Contracting Officer:

Email Address:

d. Primary Contract Specialist:

Email Address:

e. Alternate Contract Specialist:

Email Address:

2. Brief description of Scope of Work:

3. Please complete the following identifying information and past performance assessment:

a. Contractor:

b. Contract Number:

c. Period of Performance:

d. Total Contract Amount (including any Options)

e. Describe product acquired:

4. Explanation of codes:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL Performance meets contractual requirements and exceeds many (requirements). The contractual performance of the element 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). The contractual performance of the element 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 of the element 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 of the element 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 of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE Unable to provide a score. Performance in this area not applicable to effort assessed.

5. Using the codes above, place an “X” next to the appropriate letter for each item on the questionnaire and provide supporting narrative.

ASSESSMENT ELEMENTS

(1) Cost/Price Control – Rate the contractor’s ability to control cost and deliver at the agreed-to-price. Describe the reasons for changes to contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.).

E V S M U N

(2) Schedule Adherence – How well did the contractor adhere to the agreed-to schedule? What were the causes of any schedule variances? Were data deliverables and reports submitted on time?

E V S M U N

(3) Performance – Rate the contractor’s ability to successfully comply with the contract requirements, statement of work, subcontracting plan, etc.

E V S M U N

(4) Quality – How well did the contractor adhere to the requirements of a Quality Assurance Plan or Performance Based Contracting requirements? Did the services provided meet the required level of quality or results?

(5) Business Relations – Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Was turnover of personnel frequent? Rate the contractor’s responsiveness to managing changes in providing replacement personnel.

(6) What is your overall rating of the contractor’s performance?

(7) Identify the contractor’s strengths.

(8) Identify the contractor’s weaknesses.

(9) Given the choice, would you award to this contractor again? Why?

(10) Are you aware of any other efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.

6. Please provide the name title Government agency or commercial organization phone number and email address of the person completing this questionnaire.

Name of Respondent:

Title:

Government Agency/Commercial Organization:

Telephone Number:

Email address: