Attachment_2-_Past_Perf_Questionnaire_Amendment_1_Tracked_Changes.doc

Attachment 2 – Past Performance Questionnaire

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104

For Official Use Only

Please submit this form to:

Health and Human Services Office of the Assistant Secretary for Preparedness and Response Office of Acquisitions Management Contracts & Grants Carol Allen, Contracting Officer, at Carol.allen@hhs.gov FROM: _________________________________ AGENCY: ________________________________________ PHONE: _____________________________ EMAIL: ____________________________________________

REQUEST FOR PAST PERFORMANCE INFORMATION

This office is currently in the process of awarding a competitive service 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 regarding the following areas:

a. Quality of Product or Service - Conformance to contract requirements, specifications and standards of good workmanship, accuracy of reports, appropriateness of personnel, customer service and technical excellence;

b. Schedule - Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction, completed work on time, including wrap-up and contract administration, no liquidated damages assessed;

c. Cost Control - Within budget, current accurate and complete billings, actual cost/rates reflect closely to negotiated cost/rates, cost efficiency measures, adequate budgetary internal controls;

d. Management/Business Relationships - Effective management, businesslike correspondence, responsive to contract requirements, prompt notification of problems, reasonable/cooperative behavior, flexible, proactive, effective Contractor recommended solutions, timely award and management of subcontracts, effective small/small disadvantaged business subcontracting program;

e. Key Personnel - How long key personnel stayed on the contract, how well they managed their portion of the contract, the quality and relevancy of the products/services generated by key personnel.

f. Small Business - Assess compliance with all terms and conditions in the contract or order relating to Small Business participation. Assess achievement on any small business participation goals which are stated separately in the contract or order.

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, before 8 AM EST on 27 February 2017 to Carol.allen@hhs.gov. Any relevant information you have would be vital in our assessment of the aforementioned Contractor.

Thank you very much

Carol Allen Contracting Officer

PRIVATE

PAST PERFORMANCE QUESTIONNAIRE

____Cost Reimbursement

___ Other (Please Specify)

7. Period of Performance:

8. Dollar Amount of Award: $

Total Dollar Value with Mods: $

9. Title of Contract:

10. Description of Contract Service:

11. Complexity of Work: Difficult: ____________ Routine: ____________

NOTE: Please use adjectival ratings from attached sheet.

PRIVATE

12. RATING AREA

a. Quality of Service

b. Schedule/Timeliness of performance

c. Cost Control

d. Management

e. Key Personnel

f. Small Business

PRIVATE

15. Would you select this firm again? Please explain. (Attach additional sheet if necessary.)

PAST PERFORMANCE RATING GUIDELINES

The following standards shall be used in arriving at the rating:

Rating: Exceptional Definition: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective.

Rating: Very Good Definition: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective.

Rating: Satisfactory Definition: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear, or were, satisfactory.

Rating: Marginal Definition: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions. The Contractor’s proposed actions appear only marginally effective, or were not fully implemented.

Rating: Unsatisfactory Definition: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.