Attachment - Past Performance Questionnaire

NCA PAST PERFORMANCE QUESTIONNAIRE

Name/Address of Contractor

Company Name: Click here to enter text.
Division Name: Click here to enter text.
Address: Click here to enter text.
Click here to enter text.
CAGE Code:Click here to enter text.
DUNS Number: Click here to enter text.
NAICS Code: Click here to enter text.

Click here to enter text.
Work Performance
Contract Percent Complete: Click here to enter text.

Contract information
Contract Number: Click here to enter text.
Contracting Agency: Click here to enter text.
Responsible Officer: Click here to enter text.
Phone Number: Click here to enter text.
Location of Work: Click here to enter text.

Award Date: date Effective Date: date
Completion Date: date
Estimated/Actual Completion Date: date
Awarded Value: $Click here to enter text.
Current Contract Dollar Value: $Click here to enter text.

Key Subcontractors and Effort Performed

Phone# xxx-xxx-xxxxRole: Click here to enter text.
Phone# xxx-xxx-xxxxRole: Click here to enter text.
Phone# xxx-xxx-xxxxRole: Click here to enter text.
Phone# xxx-xxx-xxxxRole: Click here to enter text.
Phone# xxx-xxx-xxxxRole: Click here to enter text.

Project Number: Click here to enter text.
Project Title: Click here to enter text.

Contract Effort Description: Click here to enter text.

Small Business Utilization (%): Click here to enter text.

Evaluation Areas
Rating
Quality:
Click here to enter text.
Schedule:
Click here to enter text.
Cost Control:
Click here to enter text.
Management:
Click here to enter text.
Utilization of Small Business:
Click here to enter text.
Regulatory Compliance:
Click here to enter text.
Other Areas:
Click here to enter text.
(1) :
Click here to enter text.
(2) :
Click here to enter text.
(3) :
Click here to enter text.

Assessing Official Comments:
Additional/Other:
Click here to enter text.
Recommendation:
Click here to enter text.
Name and Title of Assessing Official:

Name: Click here to enter text.
Title: Click here to enter text.
Organization: Click here to enter text.
Phone Number: xxx-xxx-xxxx
Email Address: Click here to enter text.
Date: date

1307465788035001314450791845ADJECTIVE RATING GUIDE

00ADJECTIVE RATING GUIDE

13144501009015Rating
00Rating
26035001009015Definition
00Definition
48577501009015Note
00Note
13144501184275(E) Exceptional

00(E) Exceptional

26035001184275Performance 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.