Attachment 6: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION

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

3. Contract Information

Contract Number:
Delivery/Task Order Number (if applicable):
Cost Reimbursement
Other (Please specify):
Contract Type:
Firm Fixed Price
Contract Title:
Contract Location:
Award Date (mm/dd/yyyy):
Contract Completion Date (mm/dd/yyyy):
Actual Completion Date (mm/dd/yyyy):
Explain Differences:

Design Completion Date (mm/dd/yyyy):

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, etc.)

CLIENT INFORMATION

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/yyyy):

8. Client’s Signature:

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

E

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING

DEFINITION

(E) Exceptional

Performance meets contractual requirements and
exceeds many to the Government’s/Owner’s
benefit. The contractual performance of the
element or sub-element being assessed was
accomplished with few minor problems for
which corrective actions taken by the contractor
was highly effective.

(VG) Very Good

Performance meets contractual requirements and
exceeds some to the Government’s/Owner’s
benefit. The contractual performance of the
element or sub-element being assessed was