COP_Past_Performance_Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

Instructions for completing the Present/Past Performance Questionnaire:

1. Section A will be completed with your company’s information. All of Section “A” is information about your company.

2. The blocks “Contract number, Contract Type, Project Title and Period of Performance” are completed with information concerning a contract you feel is similar in scope to solicitation W912LQ-16-R-0002 that you wish to use as relevant performance information.

3. Section B will be completed by the company/agency you have selected for past performance.

4. Once your references have completed Section B, please have them forward the form via email, fax or mail to:

USPFO for Virginia, Acquisition Support Office ATTN: W912LQ-16-R-0002, Bldg. 316, Fort Pickett, Blackstone, VA 23824. Fax: 434-298-6202. References may also email (preferred method) the questionnaires to Ms. Susan Swanson at susan.e.swanson5.civ@mail.mil.

Present/Past Performance Evaluation Questionnaire

Section A: Contractor Information (Prior to mailing, the contractor shall place their name on the top of each page of the questionnaire prior to forwarding to customer for completion).

Contractor’s Name and Address: ___________________________________________

Point of Contact: _______________________________

Phone #: _____________________________________

Contract #: ______________________________

Project Title: ______________________________

Period of Performance: From: _________________ to: __________________

Authorization is hereby granted to provide the information requested in Section B of this Questionnaire.

Signature and Title Date

Section B: Respondent Information (To be completed by Past Performance Evaluation respondents).

Respondent’s name and address: ___________________________________________

Respondent’s name and title: _______________________________

Commercial Phone #: ___________________________ DSN Phone #: ____________________

FAX #: _________________________ Email:______________________________________

Contract #: _________________________

Contract Type: (Check all that apply) [ ] FP [ ] FP-EPA [ ] CPFF – Completion [ ] CPFF-Term [ ] CPIF [ ] CPAF [ ] ID/IQ [ ] BOA [ ] Requirements [ ] Labor Hour [ ] T&M [ ] CR [ ] Other - _________________

Project Title: __________________________________

Award Amount: _$_______________________ Final Contract Amount: _$________________________

Period of Performance: From: _________________ to: __________________

Describe subcontracting involvement if any: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Performance Evaluation Instructions: When responding to the descriptive statements, select the letter which most accurately describes the contractor’s performance or situation. If the contractor has no record of past performance relevant to a particular question, select “Neutral”.

Little Confidence Unsatisfactory / No Confidence

EVALUATION OF THE CONTRACTOR’S PERFORMANCE:

1. Quality Control: To what extent did the contractor:

a. Adhere to responsiveness/timeliness relative to performance? E V S N M U

b. Solve contract performance problems without extensive guidance from Government counterparts? E V S N M U

c. Display initiative in meeting requirements? E V S N M U

d. Display responsiveness/timeliness relative to settling customer concerns? E V S N M U

g. Manage/protect government furnished equipment (if any provided)? E V S N M U

2. Management Effectiveness: To what extent did the contractor:

a. Handle staff integrity issues, personnel retention and personnel replacement? E V S N M U

b. Ensure compliance with contract requirements and regulations? E V S N M U

e. Was the contract manager consistently available during contract performance? E V S N M U

f. Interact/Cooperate with Government personnel during performance? E V S N M U

g. How would you rate the contractor’s overall management effectiveness? E V S N M U

3. Technical Qualification/Experience: How well did the contractor:

a. Effectively perform/fulfill the contract requirements? E V S N M U

b. Provide experienced personnel with the technical and administrative abilities to meet contract requirements? E V S N M U

4. Timeliness:

a. If the contract specified timelines, were deliveries made at the appointed time and place per contract? E V S N M U

b. Did the contractor correct deficiencies in a timely manner? E V S N M U

c. Did the contractor identify problems as they occurred? E V S N M U

5. Briefly describe the contractor’s predominant STRENGTHS and/or WEAKNESSES:

6. Would you recommend to the government to award a similar contract to this contractor?

If no please provide reason/s why.

ONCE COMPLETED, THIS QUESTIONNAIRE WILL BE FOR THE CONTRACTING OFFICER’S

OFFICIAL USE ONLY.