Proposal Attachment 4 Technical Evaluation Document Past Performance Questionnaire

Contract Performance Customer Questionnaire

1. Please complete this questionnaire. Handwritten responses are sufficient. If you need more space than provided, please attach additional pages or write on the back. Responses will be treated as source selection sensitive information and will be sent directly to the Contract Specialist.

ATTN: Mimie Preston, Contracting Officer
DHS/Federal Emergency Management Agency
Phone: 202-679-9274 Email: [email protected]

2. Please complete:

Company/Contractor Requesting Reference

Agency/Company Name Providing Reference
Company/Contractor Name

Agency/Company Name

Point of Contact Name

Point of Contact Name

Phone #

POC E-mail / Phone #

E-mail address

Period of Performance

Fax Number

Supply/Service Provided

PAST PERFORMANCE RATING GUIDELINES

Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Poor, Fair, Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”

N/A - NOT APPLICABLE - Unable to provide a score. Performance in this area not applicable to effort assessed.

Ratings
Quality of Service
-Compliance w/contract requirements
-Technical excellence
-Within budget
-Relationship of
negotiated costs to
actual
Timeliness of
Delivery
-Met interim milestones
-Reliable
-Delivery Schedule achieved
Overall Customer Satisfaction
-Effective Management
-Businesslike correspondence
-Responsive to contract requirements
-Prompt notification of problems
-Reasonable/cooperative
-Flexible
-Pro-active
Unsatisfactory
Nonconformances
are comprising the achievement of contract requirements Delays are compromising achievement of contract requirements Response is not effective
Poor
Nonconformances
require major agency resources to ensure achievement of contract requirements Delays require major agency resources to ensure achievement of contract requirements Response is marginally effective
Fair
Nonconformances require minor agency resources to ensure achievement of contract requirements Delays require minor agency resources to ensure achievement of contract requirements Response is somewhat effective
Good
Nonconformances
do not impact achievement of contract requirements
Delays do not impact achievement of contract requirements