Attachment 2 - CSS Number 24322622R0014 - Past Performance Questionnaire--05.03.2022.pdf

Attachment 2 Combined Synopsis/Solicitation Number 24322622R0014

Federal Long Term Care Insurance Program Industry Market Analysis Services Past Performance Questionnaire

Part One: Instructions

The company (hereafter referred to as offeror) that provided this form to you is submitting a proposal in response to United States Office of Personnel Management (OPM) Combined Synopsis/Solicitation Number 24322622R0014 for Federal Long Term Care Insurance Program Industry Market Analysis Services. We refer to the individual who completes this form as the evaluator. Past Performance is an extremely important part of our evaluation for this acquisition. Your input is very important to us. Please send the completed questionnaire via e-mail to Cheryl D. Allen, Contracting Officer, at Cheryl.Allen@opm.gov no later than May 23, 2022, 3:00 P.M. ET. If you have questions regarding this questionnaire, please send your inquiries to the Contracting Officer, Cheryl D. Allen, at Cheryl.Allen@opm.gov.

Part Two: General Information

1. Offeror’s Name:

2. Offeror’s Address:

3. Customer Agency/Company:

4. Customer Agency/Company Address:

5. Evaluator’s Name:

6. Evaluator’s Title:

7. Evaluator’s E-mail Address:

8. Evaluator’s Telephone Number:

9. Contract Number:

10. Contract Value:

11. Contract Type (Fixed-Price, Cost-Plus-Fixed-Fee, Cost-Plus-Award-Fee, Other):

12. Contract Period of Performance:

13. Brief Description of Requirement:

mailto:Cheryl.Allen@opm.gov mailto:Cheryl.Allen@opm.gov

Part Three: Performance Measures, Ratings, and Factors

The performance measures are as follows:

Technical Effectiveness/Timeliness of Performance Management Effectiveness

The performance ratings and descriptions are provided below for your guidance.

Performance Rating Description Excellent (E): Contractor demonstrates initiative to enhance/exceed contractual requirements/objectives and overall Contractor-Government relationship is excellent.

Good (G): There are no quality-of-service problems and/or nonconformances do not impact achievement of contract goals.

Fair (F): Nonconformances are minor and have little impact on achievement of contract goals; minor Government intervention is needed to resolve issues.

Poor (P): Nonconformances are impacting achievement of contract goals; substantial Government intervention is needed to resolve issues.

Unsatisfactory (U): Nonconformances are compromising the achievement of contract goals, despite substantive intervention by Government personnel.

If a poor or unsatisfactory performance rating is given, please provide remarks on the appropriate page. If a performance factor is not applicable, please indicate that in the appropriate column.

Performance Measure: Technical Effectiveness/Timeliness of Performance

This area of the questionnaire deals with contract compliance and requirements including appropriateness of personnel, technical excellence, and the contractor’s ability to meet milestones and delivery schedules.

Performance Ratings Legend:

E = Excellent G = Good F = Fair P = Poor U = Unsatisfactory N/A = Not Applicable

Performance Factor Performance Rating

E

G

F

P

U

N/A

Adherence to and completion of major tasks, milestones, and deliverables on schedule. Adherence to project start and completion dates.

Flexibility and responsiveness to technical direction (including changes in technical direction).

Ability to identify risk factors and take measures to alleviate risk.

Effective resolution of contractor-caused delays and/or problems.

Ability to identify and solve problems expeditiously and avoid revisions and/or rework.

Technical excellence, consistency and reliability.

Appropriateness of personnel.

Overall Performance Rating for this Performance Measure:

Remarks on Poor Performance Rating(s):

Remarks on Unsatisfactory Performance Rating(s):

Performance Measure : Management Effectiveness

This area deals with the contractor’s overall communications with the government, effectiveness and reliability of key personnel, ability to recruit and maintain qualified personnel, ability to manage multiple and diverse projects from planning through execution, accurate estimate and control cost, overall performance in planning, scheduling and monitoring, management initiatives and prompt notification of problems.

Performance Ratings Legend:

E = Excellent G = Good F = Fair P = Poor U = Unsatisfactory N/A = Not Applicable

Performance Factor Performance Rating

E

G

F

P

U

N/A

Overall compliance with contract terms and conditions.

Overall communication with the Government (fact-based).

Effectiveness and reliability of contractor’s key personnel.

Ability to recruit and maintain qualified personnel.

Ability to manage multiple and diverse projects/tasks from planning through execution.

Ability to accurately estimate and control cost to complete tasks.

Overall performance in planning, scheduling, and monitoring.

Promptly notifies Government of problems.

Ability to resolve performance problems.

Overall Performance Rating for this Performance Measure:

Remarks on Poor Performance Rating(s):

Remarks on Unsatisfactory Performance Rating(s):

Part Four: Evaluator’s Certification

I hereby certify that the information on this form is accurate and complete to the best of my knowledge.

Evaluator’s Typed Name:

Evaluator’s Signature:

Evaluator’s Title:

Evaluator’s Completion Date: