2.2.1.3 Past Performance Questionnaire - 10 MVU 90-Day Effort(occ).pdf

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Attached to
10 Mobile Vaccination Units 90-Day Requirement
Solicitation number
70FB8021B00000012
Issued by

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This document contains a past performance questionnaire template for a federal solicitation seeking proposals for 10 mobile vaccination units to support COVID-19 response efforts for a 90-day period. The solicitation is being issued by the Federal Emergency Management Agency Community Survivor Assistance Section and requires mobile units with outdoor sheltered vaccination stations, with medical personnel and vaccines to be provided by state and local governments. Offerors are to submit the past performance questionnaire to identified clients who will evaluate and directly return the completed forms to the contracting officer by the closing date of August 10, 2021. The template collects information on the quality, cost controls, timeliness, management effectiveness and customer satisfaction of past or current work and includes ratings in these categories from the client.

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PAST PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

Completed PPQs shall be submitted directly from the client to the FEMA Contracting Officer, David G. Colbert at david.colbert@fema.dhs.gov prior to the solicitation closing date. Do not alter this form. No hand-written responses will be accepted or considered.

This section is to be completed by the Offeror prior to sending to Client for completion.

Solicitation 70FB8021B00000012 10 Mobile Vaccination Units – 90 Day Effort Solicitation Closing Date

August 10,2021

Company/Agency Name Point of Contact Name Address

Email Address Telephone Number

Date Sent to Client Name of Person Sent To

This section to be completed by the Client ONLY.

Name of Person Completing Form Title Contract Title Contract Number Project Description

Contract Type/Cost Award Date Original Contract Price Final Contract Price Explain Difference

Percentage of Work Performed by Contractor mailto:Tom.Madeira@fema.dhs.gov khodge3 Highlight khodge3 Highlight

Roles and Responsibilities as Prime Contractor or Subcontractor (specify Prime or Sub):

Expected Completion Date Actual Completion Date Explain Differences

1. Quality of Work:

a) How was the contractor’s compliance with applicable safety standards to protect personnel and company/agency resources?

Unsatisfactory Marginal Satisfactory Very Good Excellent

b) How was the contractor’s compliance with applicable labor standards? Not applicable – professional services Unsatisfactory Marginal Satisfactory Very Good Excellent

c) Was the contractor’s effort in Quality Control successful in ensuring quality workmanship on your project?

Unsatisfactory Marginal Satisfactory Very Good Excellent

d) Was the contractor committed to customer satisfaction?

Unsatisfactory Marginal Satisfactory Very Good Excellent

e) Overall rating for Quality of Work Unsatisfactory Marginal Satisfactory Very Good Excellent

2. Cost Controls:

a) Did the Contractor perform the required services at the contract price without adverse effect on performance?

Unsatisfactory Marginal Satisfactory Very Good Excellent

b) Did the contractor submit a fair and reasonable proposal when requested to perform additional work?

Unsatisfactory Marginal Satisfactory Very Good Excellent

c) If this contract is an indefinite delivery type contract (e.g., Multiple Award Environmental Contract, Task Order Contract, etc.), has the Contractor submitted competitive quotes on the individual orders issued under this contract?

Yes No

d) Overall rating for Cost Controls Unsatisfactory Marginal Satisfactory Very Good Excellent

N/A

3. Timeliness of Performance:

a) Was the contractor timely in submitting schedules, reports, billings and other contract submittals?

Always Usually Sometimes Never N/A

b) Was the contractor timely in responding to requests for proposals for additional work?

Always Usually Sometimes Never N/A

c) Did the contractor complete the contract on time taking into account all excusable delays?

Yes N/A

d) Was the contractor assessed any liquidated damages or deductions for late or nonperformance of required work?

If yes, please explain.

Yes

e) Did the contractor exceed contractual requirements in relation to Timeliness of Performance in a way that was deemed beneficial to your agency?

Yes N/A

If you answered No, indicate your reason by checking one of the following:

Contractor met the requirements, but did not exceed them Did not meet some of the requirements Did not meet requirements and recovery is not likely

f) Overall rating for Timeliness of Performance Unsatisfactory Marginal Satisfactory Very Good Excellent

4. Effectiveness of Management:

a) Did the contractor award subcontracts in a timely manner and properly manage them?

Always Usually Sometimes Never N/A

b) If applicable, did the contractor meet its small, small disadvantaged and women-owned business participation goals?

Yes No N/A

c) How would you rate the management of this firm as it relates to the completion of your contract and to the qualifications of its on-site personnel. Please explain.

Unsatisfactory Marginal Satisfactory Very Good Excellent

No

No

d) Describe the performance of the following personnel (if applicable)

1. Program Manger U M S VG E

2. Project Manager U M S VG E

3. Engineering/Technical U M S VG E

4. Quality Control Manager U M S VG E

5. Safety Officer U M S VG E

6. Superintendent U M S VG E

5. Customer Satisfaction:

a) Did the Contractor show reasonable and cooperative behavior and attention to customer satisfaction?

Yes N/A

If you answered NO, please explain why:

6. Overall Rating of Contractor:

In summary, which of the following would you choose to best describe the overall quality of this firm’s past performance?

Unsatisfactory Marginal Satisfactory Very Good Excellent

Blank Page
Attachment 6 Past Performance Questionnaire v2.pdf
1. Quality of Work:
2. Cost Controls:
3. Timeliness of Performance:
4. Effectiveness of Management:
5. Customer Satisfaction:
6. Overall Rating of Contractor:
June 102021CompanyAgency Name:
June 102021Point of Contact Name:
June 102021Address:
June 102021Email Address:
June 102021Telephone Number:
June 102021Date Sent to Client:
June 102021Name of Person Sent To:
Name of Person Completing Form:
Title:
Contract Title:
Contract Number:
Project Description:
Contract TypeCost:
Award Date:
Original Contract Price:
Final Contract Price:
Explain Difference:
Percentage of Work Performed by Contractor:
Roles and Responsibilities as Prime Contractor or Subcontractor specify Prime or Sub:
Expected Completion Date:
Actual Completion Date:
Explain Differences:
Unsatisfactory: Off
Marginal: Off
Satisfactory: Off
Very Good: Off
Excellent: Off
Unsatisfactory_2: Off
Marginal_2: Off
Satisfactory_2: Off
Very Good_2: Off
Excellent_2: Off
Unsatisfactory_3: Off
Marginal_3: Off
Satisfactory_3: Off
Very Good_3: Off
Excellent_3: Off
Unsatisfactory_4: Off
Marginal_4: Off
Satisfactory_4: Off
Very Good_4: Off
Excellent_4: Off
Unsatisfactory_5: Off
Marginal_5: Off
Satisfactory_5: Off
Very Good_5: Off
Excellent_5: Off
Unsatisfactory_6: Off
Marginal_6: Off
Satisfactory_6: Off
Very Good_6: Off
Excellent_6: Off
Unsatisfactory_7: Off
Marginal_7: Off
Satisfactory_7: Off
Very Good_7: Off
Excellent_7: Off
contract: Off
Unsatisfactory_8: Off
Marginal_8: Off
Satisfactory_8: Off
Very Good_8: Off
Excellent_8: Off
Always: Off
Usually: Off
Sometimes: Off
Never: Off
NA_2: Off
Always_2: Off
Usually_2: Off
Sometimes_2: Off
Never_2: Off
NA_3: Off
undefined: Off
If yes please explain: Off
deemed beneficial to your agency: Off
Contractor met the requirements but did not exceed them: Off
Did not meet some of the requirements: Off
Did not meet requirements and recovery is not likely: Off
Unsatisfactory_9: Off
Marginal_9: Off
Satisfactory_9: Off
Very Good_9: Off
Excellent_9: Off
Always_3: Off
Usually_3: Off
Sometimes_3: Off
Never_3: Off
NA_4: Off
goals: Off
Unsatisfactory_10: Off
Marginal_10: Off
Satisfactory_10: Off
Very Good_10: Off
Excellent_10: Off
U_2: Off
U_3: Off
U_4: Off
U_5: Off
U_6: Off
S: Off
S_2: Off
S_3: Off
S_4: Off
S_5: Off
S_6: Off
VG: Off
VG_2: Off
VG_3: Off
VG_4: Off
VG_5: Off
VG_6: Off
E: Off
E_2: Off
E_3: Off
E_4: Off
E_5: Off
E_6: Off
undefined_3: Off
Unsatisfactory_11: Off
Marginal_11: Off
Satisfactory_11: Off
Very Good_11: Off
Excellent_11: Off
M_2: Off
M_3: Off
M_4: Off
M_6: Off
M_5: Off
U: Off
M: Off

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