Attachment 13: Past Performance Questionnaire Past Performance Questionnaire

OFFEROR: SUBMIT TO YOUR COMMERCIAL CLIENT OR GOVERNMENT AGENCY REFERENCES FOR PAST PERFORMANCE

PAST PERFORMANCE QUESTIONNAIRE

TO BE COMPLETED BY COMMERCIAL CLIENT'S TECHNICAL MANAGER or BUSINESS MANAGER

or AGENCY'S CONTRACTING OFFICER REPRESENTATIVE (COR) or CONTRACTING OFFICER (CO)

Solicitation No.: 140G0126Q0288

Please forward completed Past Performance Questionnaire to (Contracting Officer’s name and email):

Deliver no later than close of business on (enter date):

Kimberly Schneider, [email protected]

1. Contractor Name:

2. Contract Number:

3. Contractor Address:

4. Contract Type:

5. Client / Agency Name:

6. Client / Agency Point of Contact:

Address:

Name:
Title:
Phone:
E-mail Address:

7. Period of Performance:

8. Total Contract Value: $

9. Title of Project:

10. Please describe the work that was accomplished focusing on the scope and complexity of the work.:

11. Please describe whether the work was defined by the owner via a specification, statement of work, statement of objectives, partial/complete design document.

Past Performance Questionnaire

NOTE: Please use adjectival ratings from attached sheet

13. Evaluation Factor

14. Comments (Attach additional sheets, if necessary.)

a. Quality of Services
Received

b. Personnel

c. Subcontractor Mgmt

d. Business Relations

e. Timeliness of
Performance

f. Customer Satisfaction

g. Financial Controls

h. Small Business
Subcontractor Goals
Attainment

If a subcontracting plan was required under the contract, to what extent did the offeror attain goals for small business participation?

16. Would you select this firm in the future for the same or similar services? Please explain.

17a. Name of Preparer:

17b. Signature:

17c. Title:

17d. Date:

Past Performance Questionnaire

15. Rating

PAST PERFORMANCE RATING GUIDELINES

Summarize contractor performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”
Ratings

Quality of Services
Received /
Personnel
-Compliance w/contract
requirements
-Effectiveness of design
-Quality of construction
-Accuracy of reports
-Appropriateness of
personnel assignments
-Technical excellence

Financial Controls

Timeliness of
Performance

-Within budget
-Current, accurate,