Attachment_9_-_PPQ.doc

15-223-SOL-00068

On-Site Pathology Services

Attachment #9, PAST PERFORMANCE EVALUATION QUESTIONNAIRE Part I. Contract Identification: (to be completed by Offeror) A. Offeror Information

Name:

Address:

Representative:

Telephone Number:

E-Mail Address:

B. Offeror’s Subcontractor Information (if past performance reference is for the Offeror’s subcontractor and not the Offeror itself) Name:

Telephone Number:

E-Mail Address:

C. Agency or Company (Client) Information Agency/Company Name:

Telephone Number:

E-Mail Address:

D. Contract for which this questionnaire was submitted:

Contract Number:

Role of Offeror/Subcontractor in the Contract (i.e., prime, sub):

Location of Work:

Description of Work:

Relevance of the referenced contract to the current requirement:

Problems Encountered in Performance and Corrective Actions Taken:

Part II. Evaluation (to be completed by Client) A.

Contract Information:

Agency/Company Name:

Representative/Evaluator:

Telephone Number:

E-Mail Address:

Contract Number:

Contract Type:

Period of Performance:

Original Contract Amount:

Final Contract Amount:

Description of Work Performed and the Contractor’s Association (or Major Subcontractor Association, if past performance reference is for the Offeror’s subcontractor and not the Offeror itself) with the Project (Prime, Subcontractor, etc): __________________________________________________________________

Reason for difference (if any) between original contract amount and final contract amount:

B. Contractor Performance Ratings:

Please rate the Contractor’s performance by utilizing the ratings defined below; it is imperative that ratings be accompanied by supporting narrative (comments):

1.

Timeliness of Performance

a. To what extent did the contractor adhere to contract delivery schedules? (Ratings Must Be Supported by Comments)

Outstanding

Above Average

Satisfactory

Marginal

Unsatisfactory

Comments: __________________________________________________________________

b. To what extent did the contractor submit required reports and documentation in a timely manner? (Ratings Must Be Supported by Comments)

2.

Quality of Work

a. To what extent were the contractor’s reports and documentation accurate and complete? (Ratings Must Be Supported by Comments)

b. To what extent was the contractor able to solve contract performance problems without extensive guidance from Company/Government counterparts? (Ratings Must Be Supported by Comments)

c. Did the contractor provide a product or service that conformed to contract requirements, and specifications? (Ratings Must Be Supported by Comments)

3.

Business Relations

a. To what extent did the contractor commit adequate resources to the contract in a timely fashion in order to meet the requirements and to successfully solve problems? (Ratings Must Be Supported by Comments)

b. To what extent did the contractor respond positively and promptly to technical directions, contract modifications, etc.? (Ratings Must Be Supported by Comments)

c. To what extent was the contractor committed to customer satisfaction and concerned for its customer’s interests? (Ratings Must Be Supported by Comments)

d. Has this contract been partially or completely terminated for default or convenience? (Ratings Must Be Supported by Comments)

( )Yes ( )No

( )Default ( )Convenience

If yes, explain (e.g., inability to meet cost, performance, or delivery schedule):

4. Cost Control

a. How well did the firm conform to the project budget? (Ratings Must Be Supported by Comments)

b. How effective was the Contractor in forecasting and controlling project cost? (Ratings Must Be Supported by Comments)

5.

Management of Key Personnel

a. Did the contractor use personnel with the appropriate skills and expertise to fulfill the requirements of the contract? (Ratings Must Be Supported by Comments)

b. Did the contractor retain the necessary skilled personnel and maintain a low turnover rate? (Ratings Must Be Supported by Comments)

6.

General

a. Were you satisfied overall with the Contractor’s performance?

( )Yes ( ) No Comments: __________________________________________________________________

b. Would you do business with this contractor again?

( )Yes ( ) No

C. Evaluator Information:

Name (please print):

Title:

Work phone number (including area code): _______________________________

FAX number (including area code):

E-Mail address:

Signature: