Attachment 12: Past Performance Questionnaire

ATTACHMENT 09

PAST PERFORMANCE

QUESTIONNAIRE N6883627R0001

Please return the completed questionnaire as indicated on page one (1) of SF1449, Block 8. For any questions pertaining to the questionnaire, please contact: Joseph Rojas at [email protected] and Harold Melton at [email protected]

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:
Address:
Phone Number:
Email Address:
Point of Contact:

CAGE Code:
DUNs Number:

Contact Phone Number:

2. Work Performed as:

Prime Contractor
Percent of project work performed:
If subcontractor, who was the prime (Name/ Phone #):

Subcontractor

3. Contract Information

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type:
Firm Fixed Price
Cost Reimbursement
Contract Title:
Contract Location:

Joint Venture

Other (Explain)

Other (Please specify):

Award Date (mm/dd/yr):
Contract Completion Date (mm/dd/yr):
Actual Completion Date (mm/dd/yr):
Explain Differences:
Original Contract Price (Award Amount):
Final Contract Price (to include all modifications, if applicable): Explain Differences:

4. Project Description:

Complexity of Work
High
Med
Routine
How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, as what this requirement is asking for)

CUSTOMER/CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Customer/Client Information

Name:
Title:
Phone Number:
Email Address:

SOURCE SELECTION SENSITIVE INFORMATION DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

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

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

8. Client’s Signature:

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

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING

DEFINITION

NOTE

(E) Exceptional

Performance meets contractual requirements and
exceeds many to the Government/Owner’s