15-223-SOL-00185_Atch_4_ELN_Past_Perf._Questionnaire.doc

15-223-SOL-00185 Attachment 4

Past Performance Questionnaire

INFORMATION REQUEST

PAST PERFORMANCE

The U.S. Food & Drug Administration is currently in the process of soliciting offers for a contract. [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR’S NAME] record of past performance under Contract No. [CONTRACT NO.]. Specifically, we are looking for past performance information in the following areas:

a.) Quality of Product or Service b.) Timeliness or Scheduling of Service/Deliveries c.) Business Relations/Customer Satisfaction

In order for our team to compile its evaluation, we request that you complete the attached survey form and email it, and any other pertinent information by 08 December 2015 to Jacob O’Hatnick at Jacob.ohatnick@fda.hhs.gov Any relevant information you have would be vital in our assessment of the aforementioned Contractor. Thank you for your assistance.

For your convenience, a cover sheet for use in mailing/faxing is provided below.

U.S. Food & Drug Administration Office of Acquisitions and Grants Services Attn: Jacob O’Hatnick 5630 Fishers Lane, Room 2078A Rockville, MD 20857

(Point of Contact Name)

(Facsimile/Phone Number)

(E-mail Address)

Jacob O’Hatnick

(E-mail Address)

Jacob.ohatnick@fda.hhs.gov

PAST PERFORMANCE QUESTIONNAIRE

CONTRACTOR NAME:

CONTRACT NUMBER:

EVALUATION PERIOD:

TASK ORDER NO.:

1.

Please describe the service/supply provided by the Contractor for your firm.

2. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional (E),Very Good (VG), Satisfactory (S), Marginal (M), or Unsatisfactory (U). For ratings of “Exceptional,” “Marginal,” or “Unsatisfactory,” please provide a brief explanation.

OVERALL PAST PERFORMANCE RATING

Please provide an overall rating of the contractor’s past performance for the referenced contract/delivery order a.) Quality of Product or Service:

Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence.

b.) Timeliness or Scheduling of Service/Deliveries:

Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction

Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business subcontracting program and satisfaction with Contractor’s service.

3.

Would you hire this contractor to provide services for your organization in the future? Please provide comments using additional pages if desired.

Printed Name/Title

Phone Number/Email

Signature

Date