Attachment_1_-_Past_Present_Performance_Reference_Questionnaire.pdf

Solicitation #2013-N-15633 Attachment 1

Instructions: OFFEROR shall complete the Reference Information Table themselves for the attached questionnaire, identifying the name and other pertinent information for each of three (3) selected business references. This table, including the name of the offeror, shall be filled out completely by the offeror before sending it to the references to respond to the questions. This will ensure the accuracy of the information being provided.

Send the questionnaire to each of the references with a cover letter that:

(a) authorizes the selected references to discuss the offeror’s performance under the applicable contract with the contracting officer;

(b) requests the reference complete the questionnaire;

(c) instructs the reference to return the completed questionnaire to the contracting officer by either email:

Email: kfv5@cdc.gov

Or

FAX: (770) 488-2847 Attention: Mrs. Wikiki Henton

Instruct references to call Mrs. Henton at (770) 488-2821 to confirm receipt of FAX.

mailto:kfv5@cdc.gov

PAST/PRESENT PERFORMANCE QUESTIONNAIRE (2013-N-

15633) Name of Offeror:

Reference Information Table

Business Name & Address

Point of Contact

Phone number e-mail address

Contract number with the task order number (if applicable) purchase order number, or grant number

Dollar Value

Period of Performance

Description of Services Performed

In performance of this contract, the offeror was or is the prime contractor, a subcontractor, a consultant, or other (please specify)

Explain any problems and resolutions

By submitting a questionnaire to its’ business references, the offeror authorizes the government to discuss past performance with the business reference identified in the table above.

Evaluation KEY: Please use the following abbreviations to assign an applicable rating for questions 1 thru 6 below:

P/U S G VG E N

Poor/

Unsatisfactory

Satisfactory Good Very Good Excellent Neutral

Does not meet minimum acceptable standards in one or more areas;

remedial action required in one or more areas; deficiencies in one or more areas which adversely affect overall performance.

Meets or slightly exceeds minimum acceptable standards; adequate results; reportable deficiencies with identifiable, but not substantial, effects on overall performance.

Effective performance;

fully responsive to contract requirements;

reportable deficiencies, but with little identifiable effect on overall performance.

Very effective performance; fully responsive to contract requirements;

contract requirements accomplished in a timely, efficient, and economical manner for the most part;

only minor deficiencies with minimal effect on overall

Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall

No record of relevant past performance or past performance information is not available

1. How would you rate the contractor’s compliance with the delivery schedule / performance milestones?

Comments:

P/U S G VG E N

2. How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?

3. How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service?

4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

5. How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?

6. How would you rate the contractor’s overall performance?

7. Would you purchase services from this contractor again?

YES NO

Please provide any additional comments applicable to the contractor’s past performance:

EVALUATOR NAME

TITLE OF EVALUATOR