Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION – DO NOT RELEASE

PAST PERFORMANCE COVER LETTER

DEPARTMENT OF THE

ARMY

COMMAND/ACTIVITY

LETTERHEAD

Insert Contracting Office

(DATE)

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) Number W912BU-17-R-0008

Dear Sir/Ma’am;

The US Army Corps of Engineers is currently conducting a competitive source selection to evaluate offerors on subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state or local government or commercial contracts. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to the (Insert Contracting Office and address), no later than 15 days after receipt of request or MONTH DAY, YEAR, whichever occurs first. Your questionnaire may be submitted electronically to (insert Contract Specialist email address) or (insert Contracting Officer email address).

Your cooperation is greatly appreciated. Questions may be directed to POC or the undersigned at (insert telephone number).

Sincerely, NAME

Contracting Officer

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Contractor: Contract No.:

Subcontract No. (if applicable):

POC: Title:

(Name) (E.G. PCO/ACO/TM)

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Outstanding: 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.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

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

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: 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)

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:

Forecasted or Actual Contract Completion Date: Nature of the Contractual Effort or Items Purchased:

Name:

Title:

Date:

Telephone Number: Address:

E-mail Address:

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

Outstanding (Explanation must be provided in Comments field below) Good Acceptable Marginal (Explanation must be provided in Comments field below) Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

Acceptable

A. CONTRACT IDENTIFICATION

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

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

B. Effectiveness of Project Management (to include use and control of subcontractors).

Acceptable

Acceptable

Acceptable

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:

C. Timeliness of Performance for Services and Product Deliverables.

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

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

F. General Comments. Provide any other relevant performance information.

G. Other Information Sources. Please provide the following information:

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

H. Respondent Identification. Please provide the following information:

PART III. RETURN INFORMATION