Past Performance Questionnaire_Template.pdf

Addendum to FAR 52.212-1

Instructions to Offeror for Sending Past Assessment Questionnaire & Sample Past Performance

Questionnaire Form:

Prepare and send a Reference Questionnaire package to a maximum of three (3) of your current or former clients.

For Government contracts, send to the Contracting Officer or Contract Administrator. For commercial references, send to personnel with duties similar to those for Government contracts. It is your responsibility to follow-up and encourage your references to send in their completed questionnaire before the deadline listed in the Solicitation. If you have multiple references at one location, send one cover letter and one questionnaire and list the contracts/orders for which you are requesting references. Each client should not be sent more than one reference package and may combine answers for more than one contract. A copy of the materials to be submitted to references shall be posted electronically and/or provided upon request via e-mail in MS Word format. Your questionnaire package should contain the following:

_ Cover Letter (see sample below); and _ Respondent Information Rating Sheets – Offeror should put name, contract number(s), and any other information as indicated in red text below and ensure it is on every page for identification purposes.

Performance Assessment Questionnaire – Sample Cover Letter

(Insert Command Letterhead) (Insert Date)

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) (Insert Solicitation Number)

Dear Sir/Ma’am, The US Army (insert command) is currently conducting a competitive source selection to evaluate offerors on the subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on recent and relevant federal, state, or local government or commercial contracts as compared to the North American Industry Classification System [NAICS] (insert NAICS). 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 (insert date), whichever occurs first. Submit your completed questionnaire to (insert Contracting Officer/Specialist’s email address).

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

Sincerely, (Insert name) Contracting Officer

Performance Assessment Questionnaire

[Questionnaire should include questions to assess compliance with FAR 52.219-8 and FAR 52.219-9.]

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 [and/or notify the Contracting Officer]. Please return the completed Questionnaire to the Contracting Officer identified in the cover letter within the stated timeframe.

Rating Definitions:

Substantial Confidence: 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. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: 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. The offeror has successfully performed the required effort.

Limited Confidence: 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. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror)

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:

Total Contract Value:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: rationale is required for each response.

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

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: __________________________________________________________

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

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.

Comments: _________________________________________________________

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

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:

Point of Contact (Name): __________________________________________ Telephone Number: ______________________________________________

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter.

Thank you for your assistance.