GESIS Attachment J5.pdf

J.5

Past Performance Survey

Centers for Disease Control and Prevention (CDC)

Please have your references complete this Past Performance Questionnaire and ensure that they fax their response to Centers for

Disease Control and Prevention, Procurement and Grants Office (PGO) no later than the closing date of the solicitation.

Procurement and Grants Office

ATTN: Paul Drake, M/S K-75

2920 Brandywine Road

Atlanta, GA 30341

The fax number is (770) 488-2688.

Contractor:

The above contractor has submitted a proposal to provide technical assistance and support for global HIV/AIDS activities and programs with respect to Health Management Information Systems (HMIS), monitoring and evaluation (M&E), and surveillance in response to a recent solicitation. This contractor has identified your contract listed below as containing like or similar services as required under our solicitation.

Contractor Information:

a. Program Name:

b. Contract Number:

c. Contract Type:

TO BE COMPLETED BY REFERENCE

a. Name of person completing this questionnaire: ___________________________________

b. Signature of person completing this questionnaire: ___________________________________

c. Your role with respect to the contractor (e.g., Contracting Officer/Contract Manager, COR/COTR, Program Manager, etc.):

d. Agency/company: ________________________________________________________

e. Telephone with area code: _________________________________________________

f. Fax number with area code: _________________________________________________

g. Date questionnaire completed: _________________________________________________

Please answer each of the following questions with a rating based on objective measurable performance indicators to the maximum extent possible. Commentary to explain any rating can be noted in the margins or on an attachment. For each of the following questions, please provide a rating of :

Excellent: Performance consistently exceeded contract requirements, customer expectations, and provided significant, unique or worthwhile features or benefits.

Good: Performance consistently met, and occasionally exceeded, contract requirements and customer expectations.

Demonstrated an understanding of the requirements, provided an acceptable management and technical approach, and provided complete responses to customer needs.

Satisfactory: Met the performance level of the contract.

Marginal: Usually met the contract performance level, however at a marginal level. Performance could have been improved and occasionally fell short of customer expectations.

Poor: Performance did not meet customer expectations and/or contract requirements.

1. Evaluate the contractor’s labor force in terms of overall qualifications to perform the work required.

Excellent Good Satisfactory Marginal Poor

2. Evaluate the stability of the contractor’s work force as affected by employee turnover and contract vacancies.

Excellent Good Satisfactory Marginal Poor

3. Evaluate how well the contractor conducted work in a smooth and responsive manner during the initial start up or transition period. Please indicate whether the work was transitioned from Government responsibility or another contractor’s responsibility.

Excellent Good Satisfactory Marginal Poor

Previous Contractor Responsibility Previous Government Responsibility

4. Evaluate the contractor’s adherence to task schedules and mission requirements.

Excellent Good Satisfactory Marginal Poor

5. Evaluate the contractor’s ability to provide world-wide technical assistance and support and capacity building for global

HIV/AIDS activities and programs.

Excellent Good Satisfactory Marginal Poor

6. Evaluate the contractor’s responsiveness to technical direction.

Excellent Good Satisfactory Marginal Poor

7. Evaluate the responsiveness and quality of the contractor’s reports and documentation.

Excellent Good Satisfactory Marginal Poor

8. Evaluate the contractor’s ability to solve business management problems without extensive guidance from the procuring agency.

Excellent Good Satisfactory Marginal Poor

9. Evaluate the contractor’s ability to overcome program, technical, or schedule difficulties without extensive guidance from the procuring agency.

Excellent Good Satisfactory Marginal Poor

10. Evaluate the contractor’s willingness and ability to integrate as a team and work cooperatively with the existing work force

(Government and/or other contractors).

Excellent Good Satisfactory Marginal Poor

11. Evaluate the contractor’s cost reporting and estimating system.

Excellent Good Satisfactory Marginal Poor

12. Evaluate the contractor’s overall performance.

Excellent Good Satisfactory Marginal Poor

13. Any additional narrative comments or explanations:

THANK YOU FOR COMPLETING THE QUESTIONNAIRE