Attachment 9: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference. Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

NOTICE TO CONTRACTOR

Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.
This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products or services, are approved, endorsed, or considered by the Government to be superior to other products or services. The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or other circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.

A. CONTRACTOR INFORMATION

Company Name
Street Address
City
State
Zip Code
DUNS Number
Point of Contact

Company
Address
City
State

XXXXX

XXXXXXX

Name, Email, Phone

B. CONTRACT INFORMATION

Project Title
Contract Number
Contract Type
Awarded Contract Price
Current / Final Price
Contract Award Date
Contract Completion Date
Period of Performance
Project Location
Client / Owner
Brief description of the
contract & work effort:

Title

XXXXXXXXXX

Firm Fixed Price / Time & Materials / Cost Reimbursable / Other

$X,XXX,XXX

$X,XXX,XXX

XX/XX/XXXX

XX/XX/XXXX

XX/XX/XXX – XX/XX/XXX

Park or Street address, City, State
Company
Scope of work description

C. REFERENCE:

Name
Position / Title
Organization
Phone Number
Email Address
Signature
Date

First, Last
Title
Agency or Company

XXX-XXX-XXXX

Email
Signature

XX/XX/XXXX

D. EVALUATION

3DJH
Rating
Exceptional
Very Good
Satisfactory

Definition
Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective