SB Attachment 5.pdf

11-223-SOL-00101

Attachment (5)

PAST PERFORMANCE QUESTIONNAIRE

Please complete the following questionnaire and return via regular mail or email to the attention of:

Contract Specialist, Phillip Frame by 11/04/2011 5:00 pm ET

(Title, Name) (Date & Time)

Phillip.Frame@fda.hhs.gov (Email)

5630 Fishers Lane, Room 2080, HFA500 Rockville, MD 20857-0003 (Address)

Surveys received after the deadline will not be accepted

This survey pertains to Contractor: ________________________

Department/Component:

Contract Number: Date of Survey:

Name of Person Completing Survey:

Signature of Person Completing Survey:

Your Company/Agency:

Your Role in this Contract (circle one):

Contracting Officer Contract Specialist Project Officer Other

Contract Value (including options): $

Performance Period: _____________________________________________

(Including option periods)

Type of Contract:

Approximate percentage of work being performed (or completed) by subcontractor(s):

Information on subcontractor(s) (where more than 51% of work was completed by the subcontractor):

Subcontractor Program Manager Phone

Subcontractor Program Manager Phone

Subcontractor Program Manager Phone

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support rating shall be noted on page 4.

Assign each area a rating of, 1 (Poor), 2 (Fair), 3 (Good),or 4 (Excellent).. Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle "N/A" (not applicable/no opinion).

Q UALITY OF SERVICE

1. Compliance with contract requirements 1 2 3 4 N/A

2. Accuracy of reports 1 2 3 4 N/A

3. Effectiveness of personnel 1 2 3 4 N/A

4. Technical Excellence 1 2 3 4 N/A

C OST CONTROL

1. Record of forecasting and controlling target costs 1 2 3 4 N/A

2. Current, accurate and complete billings 1 2 3 4 N/A

3. Relationship of negotiated costs to actuals 1 2 3 4 N/A

4. Cost efficiencies

T IMELINESS OF PERFORMANCE

1. Met interim milestones

2. Reliability 1 2 3 4 N/A

3. Responsive to technical direction 1 2 3 4 N/A

4. Completed on time including wrap-up and contract administration 1 2 3 4 N/A

5. Met delivery schedules

6. Liquidated damages assessed: Yes No (circle one)

B USINESS RELATIONS

1. Effective management, including management of subcontracts 1 2 3 4 N/A

2. Reasonable/cooperative behavior 1 2 3 4 N/A

3. Responsive to contract requirements 1 2 3 4 N/A

4. Notification of problems 1 2 3 4 N/A

5. Flexibility 1 2 3 4 N/A

6. Pro-active vs. reactive 1 2 3 4 N/A

7. Effective small/small disadvantaged business subcontracting program

C USTOMER SATISFACTION

1. The contractor is committed to customer satisfaction. Yes No (circle one)

2. Would you recommend selection of this firm again? Yes No (circle one)

ADDITIONAL COMMENTS:

RATING GUIDELINES

QUALITY OF

PRODUCT OR

ERVICE S

COST

CONTROL

TIMELINESS OF

PERFORMANCE

BUSINESS

RELATIONS

1-Poor

Major problems have been encountered

Contractor is having major difficulty managing costs effectively

Contractor is having major difficulty meeting milestones and delivery schedule

Response to inquiries, technical/ service/ administrative issues is marginally effective

2-Fair

Some problems have been encountered having some problems managing costs effectively

Contractor is having some problems meeting milestones and delivery schedule service/ administrative issues is somewhat effective

3-Good

Minor inefficiencies/ errors have been identified usually effective in managing costs

Contractor is usually effective in meeting milestones and delivery schedule service/ administrative issues is usually ffective e

4-Excellent

Contractor is in compliance with contract requirements and/or delivers quality products/services effective in managing costs and submits current, accurate, and complete billings

Contractor is effective in meeting milestones and delivery schedule service/ administrative issues is effective