Past_Performance_Questionaire.docx

Source Selection Information -- See FAR 2.101 and 3.104

Source Selection Information -- See FAR 2.101 and 3.104

Attachement 2

PAST PERFORMANCE INFORMATION QUESTIONNAIRE

SOLICITATION NO. 13-223-SOL-00047

PAST PERFORMANCE INFORMATION QUESTIONNAIRE

Instructions:

References are asked to complete all items set forth in this questionnaire and should return all four pages of this questionnaire no later than July 23, 2013.

The completed questionnaire can be sent to Sean Wybenga by one of the following methods:

Fax: (301) 827-6761 Email: Sean.Wybenga@fda.hhs.gov

Alternatively, references may respond to this questionnaire by phone or provide other past performance information reports/formats for the referenced contract/order.

Background Information

Name of Offeror:

Agency/Company for which Contract was performed:

Contract No:

Name and title of past performance point of contract (person completing this questionnaire):

Fax:

e-mail:

Evaluation

For each performance element identified below, references should evaluate performance information for the form identified on the prior page of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor of the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the Contractor’s control).

An individual within your organization who is knowledgeable of the Contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others within their organization, as applicable.

Date this questionnaire was completed:

Please provide answers to the questions listed below. When responding to the questions listed, circle the letter that most accurately describes the Contractor’s performance or situation (see the “ratings” chart below for a description of each letter). For any Unacceptable rating, please provide explanatory narratives in the “Remarks” section at the bottom of this questionnaire. These remarks need not be lengthy, just detailed. If more space is required, attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly.

Definitions of Potential Ratings for questions that follow:

QUALITY OF PRODUCT OR SERVICE

Contractor’s demonstrated commitment to quality customer service

E G S U N/A

Contractor’s ability to produce high quality services and related deliverables without an unreasonable number of revisions to them

E G S U N/A

TIMELINESS

Contractor’s ability to respond quickly to important matters when timely response is critical

E G S U N/A

Contractor’s ability to meet timeliness requirements for contract services and deliverable schedule

E G S U N/A

Contractor’s ability to mitigate schedule risk when unanticipated events occur

Contractor’s ability to provide qualified personnel within the period of time established in the contract.

COST CONTROL

Contractor’s ability to manage its resources within cost limitations set forth in the contract (assuming no growth in requirements)

Contractor’s ability to adequately and accurately track and report costs as required by the contract

Contractor’s ability to effectively manage the contract/order from a contract administration standpoint

OVERALL PAST PERFORMANCE RISK RATING FOR SPECIFIED CONTRACT/ORDER:

E G S U N/A (select one)

Remarks: