A01_Attachment_C_Past_Performance_Questionnaire_(SAMPLE).doc

Past Performance Assessment Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please return the completed Questionnaire within 3 days to Michael.a.Mitchell3.civ@mail.mil. A complete survey is one that addresses all questions outlined below or specifies that something is not applicable if it does not apply. Thank you.

PART I. (The Offeror being evaluated shall complete Sections A and B below)

A. CONTRACT IDENTIFICATION

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (The Point of Contact, who is evaluating the past performance of the Offeror, shall complete Sections A-I below.)

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below) Comments:

· Exceptional (Explanation must be provided in Comments field below)

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below) Comments:

· Exceptional (Explanation must be provided in Comments field below)

· Satisfactory

· Exceptional (Explanation must be provided in Comments field below)

· Extremely Satisfactory (Explanation must be provided in Comments field below)

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:

Organization:

Name:

Title:

Date:

Telephone Number :

Address:

Fax Number:

E-mail Address:

Relationship to Offeror being evaluated (i.e. subcontractor, previous KO, etc.):

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contract Specialist (michael.a.mitchell3.civ@mail.mil) identified in the cover letter.

Thank you for your assistance.

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)

C. TIMELINESS OF PERFORMANCE FOR SERVICES AND PRODUCT DELIVERABLES, INCLUDING THE ADMINISTRATIVE ASPECTS OF PERFORMANCE, TO INCLUDE ABILITY TO MEET SURGE REQUIREMENTS AND ACCELERATED DELIVERY SCHEDULES

D. EFFECTIVENESS IN FORECASTING AND CONTROLLING PROJECT COST

E. COMMITMENT TO CUSTOMER SATISFACTION AND BUSINESS-LIKE CONCERN FOR ITS CUSTOMERS’ INTERESTS

F. OVERALL SATISFACTION

G. GENERAL COMMENTS. PROVIDE ANY OTHER RELEVANT PERFORMANCE INFORMATION.

H. OTHER INFORMATION SOURCES. PLEASE PROVIDE THE FOLLOWING INFORMATION:

I. RESPONDENT IDENTIFICATION. PLEASE PROVIDE THE FOLLOWING INFORMATION:

COMPETITION SENSITIVE

FOR OFFICIAL USE ONLY