ATTACHMENT A- PAST PERFORMANCE QUESTIONNAIRE. Solicitation Attachment WORD Version

ATTACHMENT A, PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name:
Address:
Phone Number:
DUNs Number:
SAM Unique Entity Identifier (UEI) Number:
Contact Name
Email Address: :
Contact Phone Number:

2. GENERAL WORK INFORMATION

Work was performed as: ☐ Prime Contractor ☐ Sub Contractor ☐ Joint Venture ☐ Other (Please explain): Percent (%) of project work performed:
If a subcontractor, who was the prime (Name/Phone #):

3. CONTRACT INFORMATION

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type: ☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (Please explain) Contract Title:
Contract Location:
Client Contact Information:
Award Date (mm/dd/yy):
Contract Completion Date (mm/dd/yy):
Actual Completion Date (mm/dd/yy):
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
What is the degree of relevancy of this project? (Please provide details) INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requests that the client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the completed questionnaire to PBS with their proposal, and may duplicate this questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to PBS. Please contact the offeror for PBS Point of Contact information. The Government reserves the right to verify any and all information on this form.

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING

DEFINITION

NOTE

(E) Exceptional
Performance meets contractual requirements and exceeds many to the Government/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. An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.