Attachment_3_-_Past_Performance_Questionnaire.xlsx

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Medical Kits
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19AQMM18R0176
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This document contains a past performance questionnaire for a contractor bidding on a federal contract. The U.S. Department of State is soliciting proposals for the production, distribution, life-cycle monitoring, and warehousing of standardized emergency response kits and supplies to all Department posts worldwide. The contract will require procuring pharmaceutical and non-pharmaceutical medical equipment and supplies to assemble standard and custom emergency response kits, as well as executing distribution, warehouse management with a focus on security and environmental control, asset and database management for item surveillance, and life cycle sustainment program management. Bidders must identify references from past government or commercial contracts that can be contacted regarding their performance. The past performance questionnaire evaluates offerors on technical services, quality of services, timeliness of performance, price and cost controls, business relations, customer satisfaction, and overall contract performance.

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Customer Satisfaction Survey

PAST PERFORMANCE CUSTOMER SATISFACTION SURVEY
Introduction: The United States Department of State (DOS) is currently conducting a competitive procurement for the production, distribution, life-cycle monitoring, and warehousing of emergency response kits and assemblages on a global scale, for which the prospective offeror [insert name of company] has been requested to identify Government agencies or commercial vendors with whom it is currently or has been recently under contract, to serve as potential references on its past performance record. You are being asked to complete the attached Contractor Past Performance Survey. You may also be contacted by a DOS procurement official to arrange a telephone interview, using the survey as the focal point of the interview. To ensure frank and open evaluations and expressions of opinions by evaluators, all parties are advised that the identity of respondents completing the survey will be held in confidence and will not be released or disclosed to the contractor or outside the Government.
Instructions: Please complete all areas of this form indicated in light yellow.
PART I - CONTRACT INFORMATION
a. Contractor:
b. Customer Name (Federal Agency or Other):
c. Technical Point of Contact Information
i. Name:
ii. Telephone Number:
iii. E-mail Address:
iv. Position Title:
d. Contract Number:
e. Type of Contract(Select responses from drop down menu)
i. Negotiated or Sealed Bidding:
ii. Competitive or Non-Competitive:
iii. Firm-Fixed-Price, Cost-Plus, Time-and-Materials/Labor Hour, Hybrid, or Other:
iv. Indefinite Quantity, Requirements, or neither:
f. Contract Period of Performance:
h. Initial Contract Value: $
i. Current (or Completed) Contract Value: $
j. Brief Description of the Contract Requirement:
PART II - GOVERNMENT PAST PERFORMANCE/CUSTOMER SATISFACTION EVALUATION
EVALUATION CRITERIA
EXCELLENT: Indicates the Contractor's performance within the area of evaluation clearly and consistently exceeds contractual requirements.
SATISFACTORY: Indicates the Contractor's performance within the area of evaluation met the contractual requirements. If problems were identified, they were only minor in nature and solutions were provided.
MARGINAL: Indicates the area of evaluation contains or contained a problem for which there is doubt whether the identified solution is adequate but the problem appears to be within the contractor's ability to solve.
UNACCEPTABLE: Indicates the Contractor's performance within the area of evaluation experienced serious problems. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur.
NOT APPLICABLE: Performance did not include such efforts or performance was not observed.
EVALUATION AREA 1: TECHNICAL SERVICES
(Select the rating that applies from drop down menu)
Overall understanding of supply chain management for pharmaceutical and non-pharmaceutical medical equipment and supplies necessary to produce standard and custom emergency response kits and assemblages.
Demonstrated capability to execute all aspects of a successful procurement, kitting, distribution, and warehousing associated with kit/assemblage production, with a focus on physical security, environmental control, and warehouse management.
Overall understanding of supply chain risk management and implementation of appropriate risk mitigation measures.
Demonstrated capability to execute all aspects asset and database management, as well as medical item surveillance, necessary to facilitate a deliberate life cycle sustainment program and manage an unexpected product recall.
Overall ability to integrate and manage team partners and stake holders (domestic and overseas) to ensure successful mission performance
Overall ability to coordinate and integrate work to prevent unnecessary duplication of services and minimize disruptions to contract timelines
Overall effectiveness in program, risk, quality, performance management capabilities:
EVALUATION AREA 2: QUALITY OF SERVICES
(Select the rating that applies from drop down menu)
Overall ability to proactively and aggressively perform contract requirements:
Effectiveness of the contractor's training program and performance skills:
Effectiveness and reliability of contractor's key personnel:
EVALUATION AREA 3: TIMELINESS OF PERFORMANCE
(Select the rating that applies from drop down menu)
Overall performance in planning, scheduling, and monitoring:
Completion of major milestones on schedule:
Timely completion of efforts within period of performance:
EVALUATION AREA 4: PRICE/COST CONTROL
(Select the rating that applies from drop down menu)
Quality, completeness, and accuracy of price/cost proposals/invoices:
Accuracy and timeliness of cost reports:
Ability to perform within negotiated costs/prices:
Ability to provide innovative solutions that resulted in cost savings:
EVALUATION AREA 5: BUSINESS RELATIONS
(Select the rating that applies from drop down menu)
Ability to effectively manage contract:
Ability to work in collaboration with other contractors towards a common goal:
Ability to choose and manage quality subcontractors:
EVALUATION AREA 6: CUSTOMER SATISFACTION
(Select the rating that applies from drop down menu)
Maintains a single effective point of contact to manage and resolve problems:
Effectiveness in interfacing with personnel in your organization:
Overall ability to resolve performance issues:
EVALUATION AREA 7: OVERALL CONTRACT PERFORMANCE
(Select the rating that applies from drop down menu)
Based on this contractor's overall performance, would you award this contractor another contract?
COMMENTS (Please include any additional comments concerning the past performance of the contractor):
Thank You for completing this past performance evaluation. Please email the completed survey to Stephen Ching and Grayson Cochran at ChingS@state.gov and CochranGE@state.gov
U. S. Department of State
Office of Acquisition Management
ATTN: Stephen Ching
E-MAIL ADDRESS: ChingS@state.gov

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