2.2.1.3 Past Performance Questionnaire - 10 MVU 90-Day Effort(occ).pdf
PDF 315 KB Posted
- Attached to
- 10 Mobile Vaccination Units 90-Day Requirement
- Solicitation number
- 70FB8021B00000012
About this file
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.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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 |
File details come from the government source that posted it. Updated .