Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Only Section 1 is filled out by the Offeror, the balance of the form filled out by previous customers and they must email the form back to the Government.

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR

3.104

1. The contractor listed in Section 1 below (to be completed by the Offeror) is being considered in a Source Selection by the South Carolina Army National Guard. You have received this questionnaire because you have been identified as a source of Past Performance Information for that Offeror. One of the considerations in proposal evaluation is the verification of an Offeror’s past performance on contracts or other work efforts, which reflect the Offeror’s ability to successfully perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the Offeror, for the evaluation of the Offeror’s performance on those contracts or work efforts. Any comments you can provide regarding the past performance of the contractor providing this form are greatly appreciated.

2. Please complete the attached questionnaire for the contractor and program described in Section 1 below. Our areas of interest regarding the Offeror are summarized in the enclosed questionnaire. To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to Blake Cromer via e-mail at blake.s.cromer.civ@army.mil. Please DO NOT return the completed questionnaire to the contractor. The completed questionnaire will become part of official Source Selection records. We appreciate your assistance.

PLEASE FILL IN ALL SECTIONS. STATE “NOT APPLICABLE” IF QUESTION DOES NOT APPLY

OR YOU HAVE NO COMMENT. YOUR PROMPT RESPONSE WILL BE ONE OF THE KEYS TO THE

SUCCESSFUL AND TIMELY COMPLETION OF THE SOURCE SELECTION.

PAST PERFORMANCE QUESTIONNAIRE

SECTION 1: CONTRACT IDENTIFICATION (TO BE COMPLETED BY THE OFFEROR)

A. Contractor:

B. Cage Code of contractor contract was awarded to:

C. Role (check): ☐ Prime ☐ Subcontractor ☐ Teaming Partner ☐ Joint Venture Partner ☐ Other (specify)

If subcontractor, partner or other, who is the Prime?

D. Contract Number:

E. Contract Vehicle: (IDIQ Contract, IDIQ Task Order):

F. Contract Type: (CPFF, CPIF, CPAF, FFP, T&M, Other):

G. Contract Clearance Requirement (e.g. Unclassified, NAC, Secret, Top Secret):

H. Was this a competitive contract? ☐ Yes ☐ No

I. Period of performance:

J. Initial contract cost:

K. Current/final contract cost:

L. Reasons for differences between initial contract cost and final contract costs:

M. 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

Respondent’s name:

A. Respondent’s title

B. Respondent’s phone and email:

C. Respondent’s position (e.g., Program Manager, PCO/ACO, COR, etc.):

SECTION 4: EVALUATION

1. Indicate a rating, based on the description below, for the contractor’s performance on the identified program.

Underline the selected rating. Assessments should reflect only contractor liable performance. The following is a definition of the rating levels.

Exceptional

E

Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. 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.

Very Good

V

Performance meets contractual requirements and exceeds some requirements to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory

S

Performance meets contractual requirements. The contractual performance of the element being assessed contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal

M

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 actions appear only marginally effective or were not fully implemented.

Unsatisfactory

U

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.

Not Applicable

N

Unable to provide a score. Performance in this area is not applicable to the effort assessed.

2. Please provide narrative explanations to support your ratings, particularly for high or low ratings. Space for your remarks is provided after each area.

3. In addition to completing the attached questionnaire for the identified program, please provide comments on any other programs for which your activity has contracts with this contractor. You are urged to supplement your own knowledge of the contractor’s performance with the judgment of others in your organization.

FOR EACH OF THE QUESTIONS LISTED BELOW, IDENTIFY WITH AN “X” IN THE APPROPRIATE

BLOCK USING THE SCALE PROVIDED TO THE RIGHT OF EACH QUESTION.

Assessment Elements E V S M U N

Program Management

1. Rate the contractor’s ability in maximizing the promotion of safety in execution of routine services? (e.g. training of safety standards, effectively mitigating hazards, etc.)

Comments:

Mobilization

2. Rate the contractor’s ability to meet the requirements of performance on the first day of contract operations (e.g., effectively recruit, train, qualify/certify personnel; timely delivery of equipment and tools; etc.).

Functional Areas Quality of Service

3. Rate the contractor’s performance in conforming to the contract requirements, specifications and standards.

4. Rate the contractor’s ability to provide effective quality control and inspection procedures through an approved quality control plan.

5. Rate the contractor’s ability to correct deficiencies in a timely manner pursuant to their quality control procedures.

6. Rate the contractor’s ability in understanding and performing preventative maintenance of equipment.

7. Rate the contractor’s ability to ensure compliance with environmental, safety, and security.

8. Rate the contractor’s ability to prioritize and execute varying work requirements with the appropriate equipment and materials.

9. Rate the contractor’s ability to support operations for all functional areas.

10. Rate the contractor’s ability to resolve problems effectively and timely without extensive customer guidance.

Schedule

11. Rate the contractor on how well they adhered to the agreed-to schedule and provides data deliverable and reports on time. Please explain the causes of any schedule variances, if any, in the comment box?

12. Rate the contractor’s ability to perform services in a timely manner.

Staffing

13. Rate the contractor’s ability to maintain trained, certified and qualified personnel required to support all areas of the contract from the first day of contract operations and over the life of the entire contract.

14. Rate the contractor’s ability to provide and retain a qualified, stable workforce with minimal turnover of personnel; their management of personnel and ability to rapidly respond to unexpected vacancies.

15. Rate the contractor’s ability in maintaining a training plan that ensures training and certification are current from the first day of contract operations and over the life of the entire contract.

16. Rate the contractor’s ability to utilize quality subcontractors and effectively manage and coordinate their work.

Cost

17. Rate the contractor on the effectiveness and accuracy of their accounting and finance tracking/documentation.

18. Rate the contractor’s ability to provide adequate documentation to the Government to validate invoices.

19. Rate the contractor's ability to control cost and deliver at the agreed-to price. Please describe reasons for changes to contract value below.

4. Overall E V S M U N

Overall, how satisfied are you with the contractor’s performance?

4. Government Contracts Only: Has/was this contract been partially or completely terminated for convenience or default or are there any pending terminations?

☐ Yes ☐ No ☐ Convenience ☐ Default ☐ Pending Terminations

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? ☐ No ☐ Yes

If known, please provide another source that has knowledge of this contractor’s performance?

Name / Company:

Phone Number:

On the next page, please provide a summary of the Technical and Cost Performance ratings provided paying particular attention to the definitions provided above for E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions above. Please provide any information in areas where the contractor performed exceptionally well or had unsatisfactory performance or any additional comments not already addressed above.

Evaluator’s Signature Date

Please DO NOT send the completed questionnaire to the contractor.

Thank you for your prompt response and assistance!

Please return this completed questionnaire via email to:

blake.s.cromer.civ@army.mil and kevin.j.esber.mil@army.mil