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(Offeror to complete Part I prior to providing this questionnaire to the Evaluator.)
In order to assess potential vendors under the above-referenced solicitation, 70FA8023R00000002the DHS/FEMA Contracting Office is obtaining past performance information with respect to each offeror. The contract resulting from this procurement will provide DHS/FEMA with support for National Vaccination Staffing Services in support of FEMA’s operations in the United States and its territories. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. This is a critical acquisition being conducted by DHS/FEMA and your support is sincerely appreciated. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire.
CLIENT/EVALUATOR SHALL RETURN THIS QUESTIONNAIRE VIA EMAIL TO DIRECTLY TO THE FOLLOWING CONTRACTNG OFFICERS sharon.edwards3@fema.dhs.gov and michael.bonds@fema.dhs.gov
<insert your company name above>
If you need more space than provided, attach additional pages. Responses will be treated as source selection sensitive information. If you have any questions, please contact the Contracting Officers at the e-mail address indicated above.
PART I – TO BE COMPLETED BY OFFEROR AND TRANSMITTED TO CLIENT FOR COMPLETION.
A. CONTRACT INFORMATION:
NAME OF
CONTRACTOR/OFFEROR:
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| Type of Instrument (e.g. |
Contract/Order/Subcontract/Other):
| 4 |
| Contract Identification Number: |
| 5 |
| Order Number (If applicable): |
Attachment 7 - Past Performance Questionnaire Solicitation: 70FA8023R00000002
DHS/FEMA
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| Project Service Description (Add attachment if necessary): |
Negotiated, Sealed Bid):
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| Pricing Type (e.g. fixed price, |
cost reimbursement, other):
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| Follow-on Work Available |
(Y/N):
Follow-on Work Awarded to Offeror (Y/N):
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| Initial Contract Dollar Value |
(w/Options):
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| Final Contract Dollar Value |
(w/Options):
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| Period of Performance: |
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| Place(s) of Performance: |
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| Complexity of Work (e.g. |
difficult, routine, simple):
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| Type and extent of subcontracting (add rows if needed): |
PART II – TO BE COMPLETED BY OFFEROR’S CLIENT AND E-MAILED TO CONTRACTING OFFICERS
A. REFERENCE RESPONDENT INFORMATION
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| Phone Number (include area |
code):
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| Fax Number (include area code): |
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| Your Role Relative to the Project/ Contract (e.g., COTR, PM): |
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| Length of Involvement in Project/Contract: |
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| Questionnaire Completion Date: |
B. PERFORMANCE ASSESSMENT
Please rate the contractor’s performance on the identified program using the following rating scale. Assessments should reflect only contract performance for which the contractor is responsible.
Outstanding
O Based on the Offeror’s record of past performance, no issues, concerns, or risks are associated with receiving timely services and contract performance.
Good
G The Offeror’s record of past performance indicates there is very little risk associated with receiving quality products, timely services and full contract performance.
Acceptable
A The Offer’s record of past performance indicates that there is some potential risk associated with receiving quality products, timely services, and contract performance.
| Unsatisfactory |
| U |
| The Offeror’s record of past performance indicates it is likely they will fail to meet the requirements of the RFP. |
| Neutral |
| N |
| No past performance/experience available for evaluation. |
C. PAST PERFORMANCE
Rating Scale:
O - Outstanding G - Good A - Acceptable U - Unsatisfactory N – Neutral.
Place an “X” in the box for the appropriate rating.
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| Overall quality of the project |
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| Qualifications and quality of key personnel to meet |
the objectives of the project
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| Procedures that ensured the level of quality |
remained constant throughout the life of the project.
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| Adequacy, relevance and reasonableness of the |
quality management approach, procedures, documentation and methods
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| Quality of products, materials and services for the |
price paid
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| Accuracy of the record keeping procedure and ability to prepare accurate and timely reports |
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| Ability to implement effective corrective actions |
and improvements
Comments:
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| Demonstrated a process for management of the program costs and segmentation of costs for |
improved manageability
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| Demonstrated financial stability during the project |
performance period
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| Demonstrated effectiveness in reducing project |
costs from the baseline cost estimates
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| Demonstrated reasonableness of proposed |
modification costs
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| Demonstrated reasonableness in labor and O&M |
costs
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| Timeliness in completing the overall project. |
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| Completion of tasks in accordance with project |
schedule’s critical milestone dates
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| Timeliness in completing reports |
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| Timeliness of responses to client requests and |
inquiries
Rating Scale:
O - Outstanding G - Good A - Acceptable U - Unsatisfactory N – Neutral Place an “X” in the box for the appropriate rating.
| Business Relations |
| O |
| G |
| A |
| U |
| N |
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| Demonstrated a business-like concern for your |
agency’s / company’s interests
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| Relationship with client technical and functional |
personnel
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| Relationship with contracting office personnel |
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| Relationship with subcontractors |
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| Cooperation and innovation in problem solving |
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| Compliance with the terms of the contract |
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| Utilized effective program and project management |
processes, tools, and reporting
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| Had satisfactory and complete management plan |
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| Demonstrated effectiveness in use of risk |
management to proactively reduce project disruptions
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| Ability to retain key personnel |
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| Availability and accessibility of key personnel |
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| Flexible in responding to changing needs |
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| Adequate processes and metrics for the evaluation of their own overall management performance |
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| Adequate subcontractor management procedures |
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| Demonstrated effectiveness in risk identification, |
escalation, response and monitoring procedures
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| Demonstrated effectiveness in capturing incidents |
and resolving problems
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| Ability to provide a product or service that met |
your mission requirements
Based on this Contractor’s overall performance, would you award them another contract? Why or why not? Did the provided solution from this contractor work and how well did it work?
D. ADDITIONAL REMARKS
Thank you for your assistance in supporting this source selection activity.