PRESENT/PAST PERFORMANCE QUESTIONNAIRE – RFP SPE4A2-15-R-0002

(WHEN COMPLETED) SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 1

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program 

Manager):_____________________________________________________________________________________________

 _____________________________________________________________________________________________________

Agency or Business: 

______________________________________________________________________________________________________ 

______________________________________________________________________________________________________

Address: 

______________________________________________________________________________________________________ 

______________________________________________________________________________________________________

Telephone No. _______________________________ FAX No. ____________________________________ 

Return your completed questionnaire either electronically or by mail to:

Defense Supply Center Richmond

ATTN: DSCR-ARCJ, Jodi Beard

8000 Jefferson Davis Highway

Richmond, VA 23297

Phone: (804) 279-2762

Email: jodi.beard@dla.mil.

NOTICE: WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE 

RELEASED TO THE OFFEROR.

PART I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________ CAGE Code: __________

Program Title and Brief Description: 

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Role in the Program/Work Performed As: _____Prime _____Subcontractor _____Vendor/Supplier

Contract Number: ________________________________ Number of Years?: Basic:________ Option: _________

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, 

etc._________________________________________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

Period of Performance:

1. Original Schedule (assuming all options exercised): Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised): Beginning Date _________ through ____________

3. Reason for difference (if applicable)___________________________________________________________________________

Contract Dollar Value: 

1. Original MAX Contract $ Value (assuming all options are exercised: _________________________________________

2. Current MAX $ Value (assuming all options exercised): ____________________________________________________

3. Primary Causes of Changes: ___________________________________________________________________________
PRESENT/PAST PERFORMANCE QUESTIONNAIRE – RFP SPE4A2-15-R-0002

(WHEN COMPLETED) SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 2

NOTE: In Part III, should your response be other than “satisfactory,” please provide supporting documentation in “Additional

Remarks” on page 3.

PART III.PERFORMANCE ASSESSMENTS. Example only – follow RFP Section M

Please check the appropriate rating for each of the following questions (see definitions on page 4): 

U= Unknown Confidence NC= No Confidence LC=Limited Confidence SC= Satisfactory Confidence SU C= Substantial 

Confidence

 U NC LC SC SUC 

1. Extent to which Company’s products and/or services met the specification 

/performance requirements: 

2. Configuration Management (first product delivered same as last):

 

3. Quality of Completed Product: 

 

4. Overall management of subcontracting efforts:

5. Quality of Technical Manuals or Commercial Manuals:

6. Customer’s Satisfaction with warranty response times and corrective 

actions: 

7. Adequate Number of Dedicated Resources For Your Program: 

 

8. Timely recognition and notification of administrative, engineering, 

production, problems affecting the program:

 

9. Company performed independently without significant customer 

direction/oversight? 

10. Monitoring of Program Schedules and Critical Milestones: 

 

11. Completed Work on Time: 

 

12. Company demonstrated positive responsiveness to unscheduled 

requirements or contract changes: 

13. Ability of Company to contain cost or price performance in terms of 

initial reasonableness, actual experience or control of exigencies. 

14. Satisfaction with implementation plan and achievement of steady state 

operations after contract award.

15. Identification of risk areas and addressing problems with solutions

16. Collection and tracking of performance information 

17. Establishment of quality program

18. Demonstrated managerial and technical capability to perform 

requirements

19. Identification of improvements that enhance mission accomplishments

20. Overall Confidence

21. Has action been initiated to cancel or terminate the contract for default? If yes, explain. 

________________________________________________________________________________________________________

________________________________________________________________________________________________________

22. Have there been any disputes/claims relative to the contract? If yes, explain.

________________________________________________________________________________________________________

________________________________________________________________________________________________________
PRESENT/PAST PERFORMANCE QUESTIONNAIRE – RFP SPE4A2-15-R-0002

(WHEN COMPLETED) SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 3

23. Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any 

technical performance risk identified during the life of the contract. 

________________________________________________________________________________________________________

________________________________________________________________________________________________________

24. If given a choice, would you award to this contractor again? If not, please explain.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

25. Do you feel you “got what you paid for” ? Please explain. 

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

26. Additional Remarks.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

___________
PRESENT/PAST PERFORMANCE QUESTIONNAIRE – RFP SPE4A2-15-R-0002

(WHEN COMPLETED) SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY Page 4

ASSESSMENT RATING SYSTEM

Please do not include this page when returning the completed questionnaire.

Performance Confidence Assessments

Rating Description

Substantial Confidence Based on the offeror’s recent/relevant performance 

record, the Government has a high expectation that the 

offeror will successfully perform the required effort.

Satisfactory Confidence Based on the offeror’s recent/relevant performance 

record, the Government has a reasonable expectation 

that the offeror will successfully perform the required 

effort.

Limited Confidence Based on the offeror’s recent/relevant performance 

record, the Government has a low expectation that the 

offeror will successfully perform the required effort.

No Confidence Based on the offeror’s recent/relevant performance 

record, the Government has no expectation that the 

offeror will be able to successfully perform the required 

effort.

Unknown Confidence (Neutral) No recent/relevant performance record is available or the 

offeror’s performance record is so sparse that no 

meaningful confidence assessment rating can be 

reasonably assigned.

NOTICE TO QUESTIONNAIRE RESPONDENTS: Please do not include this page when returning the completed 

questionnaire.