Request for Quotations Attachment B Past Performance Questionnaire

FOR OFFICIAL USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

1. Contractor Name:

2. Contract Number:

Role on Project:

3. Contractor Address:

4. Contract Type:

☐ Firm Fixed Price

☐ T&M/LH

☐ Cost Reimbursement
☐ Other (Please Specify):

5. Procuring Agency/Company Name:

6. Agency/Company POC:

Phone:
Email:

7. Period of Performance:

8. Dollar Amount of Award: $

Annual Amount: $
Total Dollar Value w/ Mods:$

9. Title of Contract:

10. Description of Contract Service/Scope of Contract:

11. Complexity of Work:

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

NOTE: Please use adjectival ratings from attached sheet. 13. Comments (Mandatory, Attach additional sheets, if necessary.) 14. Rating

12. Evaluation Factor

a. Quality of Work

b. Personnel

c. Cost/Budget Control

d. Customer Satisfaction

e. Timeliness of
Performance/Deliverables

f. Business Relations

g. Overall Performance

15. Would you select this contractor again? Please explain. (Attach additional sheet if necessary.) Definitely

16. Name:

Probably

Definitely Not

17. Title:

Date:

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

PAST PERFORMANCE RATING GUIDELINES

Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, and Exceptional. Use the following instructions as guidance in making these evaluations. Please use the comments area on the preceding form to justify the rating given. Ratings

Quality of Work/
Personnel/Service

-Compliance w/contract
requirements
-Accuracy of reports
-Appropriateness of
personnel
-Technical excellence

Unsatisfactory

Marginal

Satisfactory

Very Good

Exceptional

Nonconformances
are comprising the
achievement of contract
reqmnts
Nonconformances
require major agency
resources to ensure
achievement of contract
reqmnts
Nonconformances
do not impact
achievement of contract
reqmnts
There are no quality
problems/issues, and the
contractor has
substantially exceeded
the contract performance
requirements without
commensurate additional
costs to the Government
The contractor has
demonstrated an
exceptional performance
level that was
significantly in excess of
anticipated achievements
and is commendable as
an example for others. It
is expected that this
rating will be used in
those rare circumstances
where contractor
performance clearly
exceeds the performance
levels described as
"Exceptional".

Cost/Budget
Control

-Within budget