Attachment_F_-_Past_Perf._Quest._Letter.pdf

ATTACHMENT F – PAST PERFORMANCE QUESTIONNAIRE LETTER

Date:

Dear Client:

We are currently responding to the Health Resources and Services Administration (HRSA) Solicitation

No. # 19-250-SOL-00045 entitled, “HRSA Center of Excellence for Behavioral Health Technical

Assistance”. The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

Email: clam@hrsa.gov

RFP # 19-250-SOL-00045

Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above email address no later than April 22, 2019 by 1:00 PM EST.

We thank you for your prompt response in this matter.

Sincerely, (To be signed by Offeror) mailto:clam@hrsa.gov

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

FOR: ________________________________________________________________________

Name of Company

PLEASE RETURN COMPLETED SURVEY TO:

Email: clam@hrsa.gov

PLEASE FILL IN THE FOLLOWING:

Your Name: ____________________________ Your Agency:________________________

Address:___________________________________________________________________

Phone Number:_________________________ Fax :________________________________

Signature of Person Completing Survey:___________________________________________

Contract Number/Solicitation Number: ____________________________________________

YOUR ROLE IN THIS CONTRACT (circle one)

Project Officer Contracting Officer Contract Specialist

Approximate Percentage of Work Competed by Subcontractors: ______ %

General Description or work or Title of Contract: _____________________________________________

RATINGS

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

mailto:clam@hrsa.gov

Standard

Contractor Performance Report

Contract Award Date: Contract Expiration Date: Contract Value:

Supplies or Services:

Ratings

Summarize contractor performance and check the number which corresponds to the rating for each rating category (See attached Rating Guidelines).

Quality of Product or Service

Unsatisfactory Poor Fair Good Excellent _Outstanding

Government Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Fixed-Price)

Unsatisfactory Poor Fair Good Excellent Outstanding

Government Comments for Cost Control (2000 characters maximum):

Timeliness of Performance

Government Comments for Timeliness of Performance (2000 characters maximum):

Contract Type: Contract Number/Order Number:

Contractor Name:

Business Relations

Government Comments for Business Relations (2000 characters maximum):

Additional Info

Subcontracts

Are subcontracts involved? __Yes __No (Check one)

Comment on subcontracts (2000 characters maximum):

Customer Satisfaction

Is/was the contractor committed to customer satisfaction? _Yes _No (Check one)

Would you recommend the selection of this firm again? _Yes _No (Check one) –

Comments on Customer Satisfaction (2000 characters maximum):

Admin Info

Project Officer/COR

Name:

Phone:

Fax:

E-mail Address:

Contracting Officer:

Name:

Phone:

Fax:

E-mail Address:

Rating Guidelines

Quality of Product or Service

Unsatisfactory Non-conformances are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

Poor Overall compliance requires significant Agency resources to ensure achievement of contract requirements.

Fair Overall compliance requires minor Agency resources to ensure achievement of

Good There are no, or very minimal, quality problems, and the Contractor has met the

Excellent There are no quality issues, and the Contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Cost Control

Unsatisfactory Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.

Poor Ability to manage cost issues requires significant Agency resources to ensure achievement of contract requirements.

Fair Ability to control cost issues requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, cost management issues and the Contractor has met the

Excellent There are no cost management issues and the Contractor has exceeded the contract requirements, achieving cost savings to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Excellent".

Timeliness of Performance

Unsatisfactory Delays are jeopardizing the achievement of contract requirements, despite use of

Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.

Poor Delays require significant Agency resources to ensure achievement of contract requirements.

Fair Delays require minor Agency resources to ensure achievement of contract requirements.

Good There are no, or minimal, delays that impact achievement of contract requirements.

Excellent There are no delays and the contractor has exceeded the agreed upon time schedule.

circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Business Relations

Unsatisfactory Response to inquiries and/or technical, service, administrative issues is not effective. If not substantially mitigated or corrected it should constitute a significant impediment in considerations for future awards.

Poor Response to inquiries and/or technical, service, administrative issues is marginally effective.

Fair Response to inquiries and/or technical, service, administrative issues is somewhat

Good Response to inquiries and/or technical, service, administrative issues is consistently

Excellent Response to inquiries and/or technical, service, administrative issues exceeds

Government expectation.

circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".