Past Performance Questionnaire.doc

Date:

Solicitation #

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and send by email to: joseph.b.jarvis.civ@army.mil

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

VENDOR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options):

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Audio Visual Equipment and Programming Installation Services for Education Center.

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (PCO/COTR/OTHER) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. DURATION OF BUSINESS RELATIONS WITH NAMED FIRM:

Please Circle the response code which best reflects your experience with this contractor.

EX = Exceptional - Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG = Very Good - Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-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 or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MG = Marginal - Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or where not fully implemented.

US = Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’ corrective actions appear or were ineffective.

N/O = Not Observed

[Please Provide Comments to Identify Specific Strengths/Weaknesses in each area) see page 2.

A. Offerors Business Practices -

Business/Contracting Relations

EX

VG

S

MG

US

N/O

Problem Resolution

EX

VG

S

MG

US

N/O

Process Improvement

EX

VG

S

MG

US

N/O

Lesson Learned Incorporation

EX

VG

S

MG

B. Customer Relationship-

Cooperative Behavior

EX

VG

S

MG

US

N/O

Commitment to Customer Satisfaction

EX

VG

S

MG

US

N/O

Responsiveness

EX VG

S

MG

US

N/O

C. Ability to Successfully Perform-

Training

EX

VG

S

MG

US

N/O

Design, Development and Performance of Course

Instruction EX

VG

S

MG

US

N/O

Course Curriculum

EX

VG

S

MG

US

N/O

Course benefit in work place EX

VG

S

MG

US

N/O

B. Prior Experience -

Personnel Technical Knowledge in subject EX

VG

S

MG

US

N/O

D. Adherence to Schedule -

Vendor adherence to scheduled dates

EX

VG

S

MG

US

N/O

E. Quality of Contractors Team-

Thoroughness EX

VG

S

MG

US

N/O

Accuracy EX

VG

S

MG

Overall Quality

EX

VG

S

MG

US

9. Overall Assessment: (a) EXCEPTIONAL (b) VERY GOOD (c) SATISFACTORY (d) MARGINAL (e) UNSATISFACTORY (f) NOT OBSERVED

10. Any unsatisfactory performance identified above has been shared with the contractor. ( ) Yes: written or oral ? ( ) No

PLEASE PROVIDE COMMENTS TO IDENTIFY:

a. Specific Strengths/Weaknesses Related to Part 8 Above -- Please Cite the Alpha-Numeric Criteria Code.

b. Two or Three Best Corporate "Traits" or Skills Observed.

c. Any Areas of Performance that are the Most "Troublesome".

Please add a continuation page for comments