7. Attachment 7 - Past Performance Questionnaire.pdf

Attachment 7 - Past Performance Reference Check Questionnaire

REFERENCE INSTRUCTIONS: The Department of Health and Human Services is considering the Offeror listed above for award of a contract. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about Offeror’s past performance. Survey should be completed by evaluator and returned to Bruce.Jackson@acf.hhs.gov.

Please evaluate the past performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.

“O” = Outstanding = Performance greatly exceeded the contract requirements “A” = Above Average = Performance exceeded the contract requirements “S” = Satisfactory = Performance met the contract requirements “M” = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory “U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements

Name of Contractor being evaluated: ______________________________________________

Respondent: ________________________________________ Date:_________________

Please rate and provide information/comments for the following: Circle one Q1. Please provide an estimated number of employees managed within a given period of performance?

Q2. Quality control: Rate the overall quality on the contractors work.

O A S M U

Q3. Were any contract discrepancy reports (CDRs), cure notices, show cause letters, suspension of payments, or terminations sent to the Contractor (if so please speak briefly to the problem areas below) and, if so, how responsive was the Contractor to correcting the discrepancies? _____________________

Yes __ No __

Q4. Rate and describe the Contractors management of staff, turnover, and how any turnover may have affected the Contractor’s performance: ____________ mailto:Bruce.Jackson@acf.hhs.gov

Q5. To what extent was contractor able to meet the performance schedule:

O A S M U

Q6. What extent was contractor flexible in responding to changing needs?

O A S M U

Q7. To what extent was the contractor reliable? _______________________

O A S M U

Q8. To what extent was the contractor responsive to technical directions?

O A S M U

Q9. If customer satisfaction surveys were conducted, did customers express satisfaction with the Contractor? If no customer satisfaction surveys conducted, please indicate so in the space provided.

Q10. Would you recommend another contract be awarded to the Contractor being evaluated? If no, please explain: ________________________________

Q11. How would you rate the Contractor on customer satisfaction?

Q12. To what extent did contractor notify you of problems or potential problems?

Q13. Business Relations:

• Was management effective?

• Did the Contractor exhibit reasonable/cooperative behavior?

• Was Contractor flexible?

• Did Contractor exhibit business-like concern for the interests of the contracting agency?

• How would you rate the Contractor in the area of business relations?

Additional Remarks: ______________________________________________