Attachment J4 PP Questionnaire for MCTA.doc

Management Consultation and Technical Assistance Services 2008-N-10241

Attachment J4

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and mail or send by facsimile (FAX 770 488-2670) to:

Centers for Disease Control and Prevention (PGO)

Office of the Director

Attn: Sandra D. Mack

2920 Brandywine Road

Atlanta, GA 30341

Desired Response Date: 27 June 2008

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

O = Outstanding

E = Excellent A = Adequate

M = Marginal P = Poor

N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

O E A M P N/O

B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

A M P

C. Schedule – Assess the timeliness of contractor against the schedule of activities.

A M P

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

A M P

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

A M P

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

A M P

G. Overall Assessment.

A M P

If an Award Fee contract, what was the average Award Fee % earned?