WEXMAC TITUS N0002325R0001 Past Performance Questionaire.docx

Attachment 1 – Past Performance Information and Questionnaire

N0002324R0001 – Worldwide Expeditionary Multiple Award Contract (WEXMAC) 2.0

PART 1 - PAST PERFORMANCE INFORMATION SHEET

OFFEROR INFORMATION (Offeror to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs Number:

Phone Number: Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: |_| Firm Fixed Price |_| Cost Reimbursement |_| Other (Please specify): Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy): Actual Completion Date (mm/dd/yy): Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

4. Project Description:

4.1 Complexity of Work: |_| High |_| Med |_| Routine

Explanation:

4.2 Financial Commitment: |_| Significant |_| Standard |_| Low

4.3 Urgency of Work: |_| Extremely Urgent |_| Urgent |_| Not Urgent

4.4 Project Relevancy: How is this project relevant to project of submission? (Please provide details such as similar equipment, supplies, services, requirements, location, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8 and Part 2)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVSUP FLCY REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVSUP FLCY WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVSUP FLCY SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVSUP FLCY. PLEASE CONTACT THE OFFEROR FOR NAVSUP FLCY POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

Source Selection Information-See FAR 2.101 and 3.104.

PART 2 - PAST PERFORMANCE QUESTIONNAIRE

TO BE COMPLETED BY CLIENT

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Title:

IN RESPONSE TO EACH TOPIC, PLEASE INDICATE WHICH ADJECTIVE BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E

VG

S

M

U

N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E

VG

S

M

U

N

3. CUSTOMER SATISFACTION:

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E

VG

S

M

U

N

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back- up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

VG

S

M

U

N

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

Yes

No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes

No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes

No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

VG

S

M

U

N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

VG

S

M

U

N

c) Would you hire or work with this firm again? (If no, please explain below)

Yes

No

If needed, please provide supplemental explanations to the above questions in the space below: