ATTACHMENT_C_and_D_Past_Perf_Project_Form_and_Questionairre.docx

DOCX document 20 KB Posted Apr 5, 2018

Attached to: Medical Support Services - Dept. of State
Solicitation number: 19AQMM18R0082
Issued by: Department of State Office of Acquisition Management

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Past Performance Project Form and Questionnaire Form

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File	Type	Posted
Attachment_B,_Priceworksheet_Med_Support.xlsx	XLSX spreadsheet	Apr 30, 2018
A001_Amend_19AQMM18R0082_Med_Sup.pdf	PDF	Apr 30, 2018
Medical_Professional_services_SOW.docx	DOCX document	Apr 30, 2018
ATTACHMENT_C_and_D_Past_Perf_Project_Form_and_Questionairre.docx	DOCX document	Apr 30, 2018
Q&A_MED_Support_Final.pdf	PDF	Apr 30, 2018
Attachment_B,_Priceworksheet_Med_Support.xlsx	XLSX spreadsheet	Apr 5, 2018
Medical_Professional_services_SOW.docx	DOCX document	Apr 5, 2018
19AQMM18R0082_Med_Support_Final_All.pdf	PDF	Apr 5, 2018

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19AQMM18R0082, ATTACHMENT C - PAST PROJECT FORM

1. Name of Offeror

1a. Solicitation Number

2. Complete Name of Government Agency, Commercial Firm, or other Organization

3. Complete Address

4. Contract Number or Other Reference

5. Date of Contract Award

6. Total Contract Price (to include all options)

7. Period of Performance (to include all options)

8. Clearance Required:

(If applicable) Type/Level:

9a. Number of Productive Consultant Hours Per Annum

9b. Categories of Consultants

10a. Technical point of contact (name, title, address, telephone no., and email address)

10b. Contracting or purchasing point of contact (name, title, address, telephone no., and email address)

11. Geographic Location of work (Country, State or Province, County, City)

12. Description of contract work. In order to establish the relevance of your project to the instant requirement, please describe the scope, magnitude and complexity of this work, comparing and contrasting it to that required under this solicitation. Additionally, describe any unique or unusual requirements of the contract, and performance problems or issues encountered under the performance of the contract. For problems/issues noted, describe the method of resolution and/or corrective actions taken. Use a continuation sheet, if necessary.

13. Name(s) of subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

Instructions for Completing the Past Project Form

Item1	Insert Name of Offeror
Item 1a	Insert Solicitation Number
Item 2	Insert the complete name of the customer, including parent organization. Do not use acronyms.
Item 3	Insert the customer's complete address, including both post office box and street address, if possible.
Item 4	Insert any contract number or other contract reference used by the customer.
Item 5	Insert the date on which the contract came into existence.
Item 6	Insert the price, as it appeared in the original contract inclusive of all option periods. If the contract included multiple, separately-priced items, add the individual item amounts and insert the total price.
Item 7	Insert the period of performance to include all option periods (if applicable).
Item 8	Annotate whether or not a clearance was required. If applicable, insert the type clearance, i.e. Top Secret, Secret)
Item 9a	Insert the number of productive consultant hours under the contract on an annual basis.
Item 9b	Indicate what type of consultants were required. (i.e. procurement, finance, budget project management)
Item 10a	Insert the name, title, address, telephone number, and email address (if available) of the program or project manager, quality assurance representative, or other customer technical representative who is most familiar with the quality of your work under the contract.
Item 10b	Insert the name, title, address, telephone number, and email address (if available) of the contracting officer, purchasing agent, or other customer contracting or purchasing representative who is most familiar with your work under the contract.
Item 11	Insert the location(s) where the work was performed, including the country (if other than the United States) and the state or province, county (if applicable), and city. If contract requires services at multiple locations, identify all locations.
Item 12	Describe the nature and scope of the work. The objective is to show how the work that you did or are doing is similar in nature and scope to the work that is to be performed under the contract contemplated by the request for proposal. Describe any unique or unusual requirements of the contract and any problems encountered during the performance of this contract work. Tell your side of the story of any conflicts with the customer concerning which they may make adverse remarks about your performance. Describe any actions that you have taken or plan to take to correct any shortcomings in your performance.
Item 13	Insert the name, address, telephone number, and email address (if available) of the subcontractor(s) used, if any, and a description of the extent of work performed by the subcontractor(s).

19AQMM18R0082, ATTACHMENT D

PAST PERFORMANCE QUESTIONNAIRE

LOCKSMITH SERVICES FOR THE DEPARTMENT OF STATE

NAME OF CONTRACTOR REQUESTING THE REFERENCE:

The purpose of this questionnaire is to obtain information regarding the quality of the above named Contractor’s past performance relative to a contract, completed or in progress, at your company/agency. The Department of State is considering this company for medical professional support services. We would greatly appreciate your input regarding the quality of the Contractor’s past performance.

Handwritten responses are sufficient. It is requested that the individual(s) responsible for the administrative oversight of the project (e.g. security specialist, COR, etc.) respond to this questionnaire. More than one copy of the questionnaire may be submitted if responses from more than one individual are appropriate.

Upon completion of the survey, please email thumanwg@state.gov. If you have any questions, please call (703) 875-6992. We appreciate your efforts on our behalf.

PROJECT TITLE AND LOCATION:_________________________________________

AWARD DATE:_________________________________________

CONTRACT COMPLETION DATE:_________________________________________

CONTRACT COST PER YEAR:____________________________________________

AVERAGE NUMBER OF CONSULTANTS PER YEAR: ______________________________

DESCRIPTION

Please provide a brief description of the scope of this project so that we determine the similarities to our contract:

QUESTIONS

Please rate their quality of service.

Please rate their program/project contract management.

Please rate responsiveness.

How well did they meet mission requirements? Identify any major issues and how they were resolved.

How efficiently did they handle trouble calls and complaints?

Were there any invoicing issues? If so, please describe the issues and how well they were addressed.

How well did they manage quality control?

Please rate this service provider.

What is the rationale for your service provider rating?

Note: All ratings will be on a scale of 1-5 with 1 being poor and 5 being excellent.

Would you recommend this firm to other agencies? Circle one:

Highly Recommend

Recommend

Would Not Recommend

Overall how would you rate the Quality of the Contractor’s Performance?

Please circle one

Outstanding – Requirements are consistently being exceeded and performance is consistently of high quality

Satisfactory – Requirements are consistently being met and performance is generally adequate or better.

Marginal – Requirements are generally met, however sometimes performance is less than adequate

Unsatisfactory – Requirements are generally not being met or performance is consistently of poor quality.

Once again, thank you for you taking the time to provide this reference information. In closing, we ask that you provide the information below in case we need to contact you to clarify a response.

Your Name: ______________________________

Your Position: ____________________________

Company: ________________________________

Telephone No: ____________________________

E-mail Address: _____________

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