Attachment_1_Past_Perf_Questionnaire.pdf

ATTACHMENT 1 - PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

Attachment 1 SOURCE SELECTION SENSITIVE

SEE FAR 2.101 AND FAR 3.104

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PROGRAM SUPPORT CENTER

On behalf of

DEFENSE ADVANCED RESEARCH PROJECTS AGENCY (DARPA)

DEFENSE SCIENCES OFFICE (DSO)

SOLICITATION NUMBER:

I. COMPLETION OF QUESTIONNAIRE: The information obtained from this questionnaire will be utilized to evaluate the past and present performance of Offerors submitting proposals in response to the Department of Interior (on behalf of DARPA/DSO) Request for Proposals for Scientific, Engineering, Technical Assistance, and Administrative (SETA) support.

Complete all sections of the identifying information and attached past performance questionnaire. The information you provide will be instrumental in allowing the Government to evaluate how well the contractor performed under your contract(s). Responses will be treated as source selection sensitive information. Comments are encouraged and would be appreciated. The last page may be used if additional space is needed for comments. Clear handwritten responses are sufficient. This information shall be submitted no later than the proposal due date. Return the completed questionnaire by e-mail or delivered to the address below:

Email to: Richard.Authier@psc.hhs.gov

(U.S. Mail/FedEx/UPS) Department of the Interior, Interior Business Center, Acquisition Services Directorate, Division III, 354 South Highway 92 Sierra Vista, AZ 85635

II. EXPLANATION OF CODES:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many

(requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE – Unable to provide a score. Performance in this area not applicable to the effort assessed.

PLEASE COMPLETE THE FOLLOWING IDENTIFYING INFORMATION AND PAST

PERFORMANCE QUESTIONNAIRE:

CONTRACTOR IDENTIFICATION:

CONTRACTOR’S NAME & ADDRESS:

DESCRIPTION OF

REQUIREMENT

(SCOPE)/COMPLEXITY:

CONTRACT NUMBER:

TOTAL CONTRACT VALUE

(INCLUDING OPTIONS):

CONTRACT TYPE (check all that apply):

FIXED PRICE COST + FEE

TIME & MATERIAL

COMPETITIVE NON-COMPETITIVE

SET-ASIDE SEALED BID

NEGOTIATED

PERIOD OF PERFORMANCE

(INCLUDING OPTIONS):

DEGREE OF SUBCONTRACTING TEAMING:

EVALUATOR INFORMATION:

YOUR NAME & TITLE

YOUR ORGANIZATIONAL

ADDRESS

TEL NO.:

FAX:

E-MAIL:

Relation to Program (i.e. CO, Specialist, Contracting Officer’s Representative, (etc):

TERMINATION HISTORY:

1. Has this contract been partially or completely terminated for default or convenience?

YES NO DEFAULT CONVENIENCE

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

2. Are there any pending terminations? YES NO

If yes, explain and indicate the status.

ASSESSMENT ELEMENTS: Place an “X” in the appropriate box next to the letter for each item on the questionnaire. Narrative statements are vital. Please provide a supporting narrative for each area. Attach additional pages if there is insufficient space in the comment space.

1. QUALITY OF PRODUCT/SERVICE (e.g., quality of information technology support services, phase-in support, reports, etc.) Does the contractor provide qualified personnel, necessary resources, and quality control? Does the contractor meet established guidelines and policies for safety and security? Did the product/service meet the required level of quality?

E V S M U N

2. SCHEDULE (i.e., Does the Contractor provide adequate staffing to meet workload requirements and emergency restoration requirements and is the work performed in a timely manner and in accordance with the requirement?)

E V S M U N

3. COST CONTROL (e.g., Were obligations performed within the ceiling price in the contract, are contractor requests for employee overtime reasonable, are proposals for equitable adjustments and special projects reasonable, etc.)

E V S M U N

4. BUSINESS RELATIONS (e.g., are contractor personnel promoting a strong working relationship with the Government, does the contractor adequately address and make efforts to resolve issues/problems concerning site employees, does the contractor show initiative, were contractor personnel courteous and responsive, does the contractor interface effectively with your staff, etc.)

E V S M U N

5. MANAGEMENT OF KEY PERSONNEL (e.g., is the contractor providing the site manager/leader or key employees with the necessary resources and support to adequately perform their work, does the contractor adequately address and make efforts to resolve issues/problems concerning the site manager/leader or key employees, is the contractor able to solve contract performance problems without extensive guidance from government counterparts, etc.)

E V S M U N

6. Did the contractor adhere to their technical and management approach?

YES NO

If no, explain what was different.

7. Please comment on any other contractor information you consider relevant to this evaluation.

8. Identify the contractor’s overall strengths and weaknesses.

9. If there were problems, did the contractor act promptly to resolve them? How affective was the contractor’s corrective action?

10. Given the choice, would you award to this contractor again? YES NO