Attachment_A_-_PP_Questionnaire.pdf

Solicitation 17-258-SOL-00021; Title: NHDP Funeral and Burial Services; Attachment C – Past Performance Questionnaire

ATTACHMENT A

PAST PERFORMANCE QUESTIONNAIRE (PP)

[17-258-SOL-00021]

FOR: ______________________________________________________________________________

(Name of contractor that past performance information is being provided for)

RETURN COMPLETED SURVEY BY June 30, 2017 at 2:00 PM Eastern Time

Attention: Charisse Whitney Email: CWhitney@hrsa.gov

SECTION 1:

CONTRACT INFORMATION RELATED TO QUESTIONNAIRE:

Contract Title: ______________________________

Contract Award Date: ______________________________

Contract End Date: ______________________________

Contract Value: ______________________________

Contractor Name: ______________________________

Contractor Address: __________________________________________________________________ mailto:CWhitney@hrsa.gov

SECTION 2:

INFORMATION RELATED TO ENTITY/COMPANY PROVIDING QUESTIONNAIRE:

Name of Person Completing Questionnaire: ______________________________

Name of Company/Entity: ______________________________

Address: ___________________________________________________________________________

Phone Number: ______________________________

Fax Number: ______________________________

Email Address: ______________________________

CONTRACT ROLE OF PERSON COMPLETING QUESTIONNAIRE (Check One):

Project Officer

Contracting Officer

Contract Specialist

GENERAL DESCRIPTION OF CONTRACT SCOPE OF WORK:

APPROXIMATE PERCENTAGE OF WORK COMPLETED BY SUBCONTRACTORS:

RATINGS:

*Please provide a rating for each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

QUALITY OF PRODUCT OR SERVICE RATING ________:

0 = Unsatisfactory - Non-conformances jeopardized the achievement of contract requirements, despite use of agency resources. Performance that could not be substantially corrected constituted a significant impediment in consideration for future awards containing similar requirements.

1 = Poor - Overall compliance required significant agency resources to ensure achievement of contract requirements.

2 = Fair - Overall compliance required minor agency resources to ensure achievement of contract requirements.

3 = Good - There were no, or very minimal, quality problems, and the contractor met the contract requirements.

4 = Excellent - There were no quality issues, and the Contractor substantially exceeded the contract performance requirements.

5 = Outstanding - The contractor demonstrated an outstanding performance level that was significantly in excess of anticipated achievements, exceeded the contract performance requirements and is commendable as an example for others.

COST CONTROL RATING ________:

0 = Unsatisfactory - Ability to manage cost issues jeopardized performance of contract requirements, despite use of agency resources. Performance that could not be substantially corrected constituted a significant impediment in consideration for future awards containing similar requirements.

1 = Poor - Ability to manage cost issues required significant agency resources to ensure achievement of contract requirements.

2 = Fair - Ability to control cost issues required minor agency resources to ensure achievement of contract requirements.

3 = Good - There are no, or very minimal, cost management issues and the contractor met the contract requirements.

4 = Excellent - There were no cost management issues and the contractor exceeded the contract requirements, achieving cost savings for the Government.

5 = Outstanding - The contractor demonstrated an outstanding performance level that was significantly in excess of anticipated achievements, exceeded the contract performance requirements and is commendable as an example for others.

TIMELINESS OF PERFORMANCE RATING ________:

0 = Unsatisfactory - Delays jeopardized the achievement of contract requirements, despite use of agency resources. Performance that could not be substantially corrected constituted a significant impediment in consideration for future awards containing similar requirements.

1 = Poor - Delays required significant agency resources to ensure achievement of contract requirements.

2 = Fair - Delays required minor agency resources to ensure achievement of contract requirements.

3 = Good - There were no, or minimal, delays that and the contractor met the contract requirements.

4 = Excellent - There were no delays and the contractor exceeded the contract requirements and agreed upon time schedule.

5 = Outstanding - The contractor demonstrated an outstanding performance level that was significantly in excess of anticipated achievement, exceeded the contract performance requirements and is commendable as an example for others.

BUSINESS RELATIONS RATING ________:

0 = Unsatisfactory - Response to inquiries and/or technical, service, administrative issues were not effective. Performance that could not be substantially corrected constituted a significant impediment in consideration for future awards containing similar requirements.

1 = Poor - Response to inquiries and/or technical, service, administrative issues was marginally effective, requiring significant agency resources to ensure achievement of contract requirements.

2 = Fair - Response to inquiries and/or technical, service, administrative issues was somewhat effective, requiring minor agency resources to ensure achievement of contract requirements.

3 = Good - Response to inquiries and/or technical, service, administrative issues was consistently effective and the contractor met the contract requirements.

4 = Excellent - Response to inquiries and/or technical, service, administrative issues exceeded Government expectation and the contractor exceeded the contract requirements.

5 = Outstanding - The contractor demonstrated an outstanding performance level that was significantly in excess of anticipated achievement, exceeded the contract performance requirements and is commendable as an example for others.