ATTACHMENT_C_-_PAST_PERFORMANCE_QUESTIONNAIRE.DOCX

Attachment C

PAST PERFORMANCE QUESTIONNAIRE

Submission instructions for the Past Performance Evaluation Questionnaire –

The contractor shall identify three (3) contracts/task orders with the Federal Government and/or commercial customers that demonstrate recent and relevant past performance. Recent is defined as within the last three years. Relevant is defined as work similar in complexity and magnitude of the work described in this SOW.

The contractor shall ensure that the Past Performance Evaluation Questionnaire should be completed by at least three separate customers and returned to this office no later than 3:00 pm EST on July 11, 2013. Questionnaires shall be submitted via e-mail to korriise.laroche@psc.hhs.gov

Note: Sections I and II shall be completed by the Offeror. The remaining portion will be completed by the Respondent.

I. Contractor Identification Contractor Name:

Contractor Address:

Contractor Key Personnel:

II. Contract Information

Program Name:

Client:

Contract Type: ( ) FFP ( ) Cost ( ) Other (Specify):

Contract Value:

Complexity:

Descriptions of Services:

III. Contractor Performance Ratings Solicitation No. 13-233-SOL-00405

Please rate the Contractor‘s performance for items 1 through 4, utilizing the rating scales and rating guidance provided below:

1. Quality of Services

Compliance with contract requirements ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

2. Cost Control (Not required for Fixed-Price Contracts)

Forecasting and Controlling Target Costs ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

Current, Accurate, and Complete Billing ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

3. Timeliness of Performance

Response to Technical Direction ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

4. Business Relations

Effective Management, including subcontracts ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

Reasonable/Cooperative behavior ( ) Unsatisfactory ( ) Poor ( ) Fair ( ) Good ( ) Excellent ( ) Outstanding

Rating Guidance

Quality of Product or Service

U n s a t i s f a c t o ry N on co n f o r ma n ce s are je op a r d izi n g t h e ac h ie v eme n t o f c on tra c t r e qu ire m e n ts, d e s p i t e u se o f

Cl i e n t r e s ou r ce

s. R ec o ve r y is no t l i ke l y

I f p e r f o r ma n c e ca nno t b e s ub st a n t i a l l y c o rr ec te d it co n sti t u tes a si g n i f ic a n t i m p e d i m e n t in c on si d e r a t i o n f o r f u t u re a w a r d s c on ta i n i n g si m i l a r r e qu ire m e n ts.

Poo r

O v e r a ll c o m p l i a n c e r e qu ires si g n if ic a n t

Cl i e n t r e s ou r ce s to e n s u re a c h ie v e m e n t o f c on tra c t r e qu ire m en ts.

F a ir

O v e r a ll c o m p l i a n c e r e qu ires m i no r

Cl i e n t r e s o u r ce s to e n s u re ac h ie v e m e n t o f c on tra c t r e qu ire m e n ts.

G oo d

T h e re a re no o r ve ry m i n i m a l, q ua l i ty p r ob le m s, a n d t h e C o n tra c t o r h a s m e t t h e c on tra c t r e q u ire m e n ts.

E xce l l e n t

T h e re a re n o qu a l i ty iss u e s, a n d t h e C o n tra c t o r h a s s ub st a n t ially e x cee d e d t h e c o n tra c t p e r f o r m a nc e r e qu ire m e n ts w i thou t c o m me n s u r a te a dd i t i on a l c o sts to t h e Cl i e n t O u tsta nd i n g

T h e C on tra c t o r h a s d e m on str a ted a n o u tsta nd i n g p e r f o r m a n c e l e ve l t h a t w a s si g n i f i ca n t l y in exce ss o f a n t i c i p a t e d ac h ie v e me n ts a n d is c o m me nd a b l e a s an ex a m p le f o r o t h e rs, s o t h a t it j u s t i f ies a dd i n g a p o i n t to t h e s c o r e

It is ex p ec ted t h a t t h is r a t i n g w i l l b e u s e d in t ho se r a re c irc u m st a n ce s w h e re c on tra c t o r p e r f o r m a nc e c le a r ly e xc e e d s t h e p e r f o r m a n c e l e ve ls d e s c r i b e d a s E x c e l l e n t

Cost Control

U n s a t i s f a c t o ry A b i l i t y to m a n a g e c o st i s s u e s is je op a r d iz i n g p e r f o r m a n c e o f c on tra c t r e qu ire m e n ts, d e s p i t e u se o f

Cl i e n t r e s ou r ce s.

R ec o ve r y is no t l i ke l y

If p e r f o r ma n c e ca nno t b e s ub st an t ially c o rr ec t e d t h is le v e l o f a b i l i t y to m a n a g e c o st i s s u e s c on sti t u tes a si g n i f ic a n t i m p e d i m e n t in c on s i d e r a t i o n f o r f u t u re a w a r d s.

Poo r

A b i l i t y to m a n a g e c o st i s s u e s re qu ires si g n i f ic a n t

Cl i e n t r e s o u r ce s to e n s u re ac h ie v e m e n t o f c on tra c t r e qu ire m e n ts.

F a ir

A b i l i t y to c on t r o l c o st i s s u e s re q u ires m i no r

Cl i e n t r e s o u r ce s to e n s u re ac h ie v e m e n t o f c on tra c t r e qu i r e m e n ts.

G oo d

T h e re a re no o r ve ry m i n i m a l, c o st m a na g e me n t iss u e s a n d t h e C o n tra c t o r h a s m e t t h e c on tra c t r e q u ire me n ts.

E xce l l e n t

T h e re a re n o c o st m a n ag e me n t iss u e s a n d t h e C o n tra c t o r h a s e x cee d e d t h e co n tra c t r eq u ire m e n ts, ac h ie v i n g c o st s av i n g s to t h e Cl i e n t O u tsta nd i n g

T h e C on tra c t o r h a s d e m on str a ted a n o u tsta nd i n g p e r f o r m a n c e l e ve l t h a t j u s t i f ies a dd i n g a p o i n t to t h e s c o r e

It is ex p ec ted t h a t t h is r a t i n g w i l l b e u s e d in t ho se r a re c irc u m st a n ce s w h e re t h e C o n tra c t o r ac h ie v e d c o st s av i n g s a n d p e r f o r m a n c e c le a r l y e x cee d s t h e p e r f o r m a n c e le v e ls d e s c ri b e d a s E xce l l e n t