Attachment 4: Past-Performance-Questionnaire

Past Performance Questionnaire Template

Instructions:

Sections I and II to be completed by the Offeror/Major Subcontractor and provided to the assessor (Government personnel that had experience with the Offeror/Major Subcontractor on a previous relevant contract). The assessor, in turn, to verify Sections I through III, complete the questionnaire, and submit to the Contracting Office. The Offeror should also submit with its proposal (by the closing date of the Solicitation) copies of Sections I and II of all questionnaires as provided to assessors.

Section II to be validated by the assessor. If any information is incorrect herein, please annotate and provide the correct information accordingly.

Sections III through IV to be completed in their entirety by the assessor.

Message to the assessor: Your feedback is requested by NOAA to assist with establishing the performance history for the Contractor named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you please e-mail the completed questionnaire(s) to: [email protected].

I. Solicitation Data (for the proposed effort)

Solicitation Number
1305M327Q0034
Project/Requirement
Milford Sea Water Pump Renovation
Customer/Agency

NOAA (AGO)

Project/Requirement Description
Non-personal services for sea water pump renovation at Milford.

II. Current or Historical Contract Information

Assessor: The performance data submitted by the Offeror is ☐ correct or ☐ incorrect.

CONTRACTOR NAME & ADDRESS:

Contract No

Type of Contract

Initial
Final

Contract Value

Period of Performance/Delivery Schedule

Project/Requirement Description

Please select from the following as it applies to this contract:

Contracting Role

☐ PRIME

☐ SUBCONTRACTOR

Termination History
☐ Convenience
☐ Default
☐ N/A

III. Assessor Information

Assessor Name

Title

Phone Number/Email Address

Identify your role in the contract award or administration and the period of your involvement. ✔
Role
Period of Involvement

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO)

Contract Specialist

Contracting Officer’s Representative (COR)

Technical Project Lead/Project Officer

Quality Assurance Specialist

Defense Contract Audit Agency (DCAA) Auditor

Other:

IV. Overall Performance Rating
Please provide the overall performance rating based on performance of contract requirements, quality and timeliness of delivery of goods, services and/or construction, cost management, communications between contracting parties, proactive management and/or customer satisfaction.