Attachment_8_Past_Performance_Questionnaire.pdf

APPENDIX C

Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

The Department of Homeland Security (DHS), FEMA, recently released a Request for proposal for the procurement of housing inspection services under RFP #70FB7019R00000008. Offerors are asked to provide information on contracts or subcontracts similar in nature, size and complexity to the immediate requirement performed in the past. An offeror has submitted this to your company as a reference for past performance. (See blocks 1 to 3 below).

FEMA requests your opinion on the contractor’s performance on your contract(s). Please fill out the attached questionnaire and send it electronically to either the Contracting Officer, Dennis C. Clements, at dennis.clements@fema.dhs.gov or the Contract Specialist, Maurice D. Randolph, at maurice.randolph@fema.dhs.gov. To be considered, this form must be filled out and received by the Contracting Officer no later than the closing date and time listed in the request for proposal. DHS/FEMA may contact you to clarify or verify any information provided. For purposes of confidentiality, only send this completed form to the FEMA Contracting Officer or Contract Specialist.

Your input will be confidential. Please note your comments will be used to form the basis for evaluation of this offeror. Thank you in advance for your assistance. If you have any questions please contact the Contracting Officer at 470-295-5408 or the Contract Specialist at 202-705-9861.

A. CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Block 1. Contractor Name:

Block 2. Contractor phone number and address:

Block 3. Contract Name and Number: |

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE AND

COMPLETE TO THE BEST OF MY KNOWLEDGE.

Evaluator’s Printed Name Title Evaluator’s Mailing Address (Agency, Bldg/Room, Street, City, State, Zip)

Evaluator’s Signature Date Phone Fax

B. INSTRUCTIONS

Two forms are provided to document your opinion: 1) Performance Rating Form; and 2) Supplemental Comment Form. Please fill out both forms in accordance with the instructions provided on each. Please use the following standards in arriving at your rating: 1) Superior – the contractor’s overall performance was superior. Satisfactory

– the contractor’s overall performance was successful but with some minor exceptions 2) Unsatisfactory – the contractor’s overall performance was unsatisfactory.

PERFORMANCE RATING FORM (put an X in the appropriate box)

Performance Element Superior Satisfactory Unsatisfactory Not Applicable

1. QUALITY OF

PRODUCT/SERVICES: The contractor provided high quality products and/or services and conformed to the contract statement of work and standards.

2. COMMUNICATION: The contractor worked and communicated well with client management and contracting officials.

3. TIMELINESS OF PERFORMANCE:

The contractor adhered to contract schedules (both administrative and technical aspects of schedule compliance)

4. CUSTOMER SATISFACTION: The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.

5. RESPONSIVENESS AND

ATTENTIVESNESS: The contractor was accurate and responsive to client changes, technical direction, rejection of contract deliverables and in detecting and correcting errors, poor performance, and other problems.

6. MANAGERIAL AND TECHNICAL

CAPABILITY: The contractor’s managerial and technical capability was effective.

7. SUBCONTRACTOR: The contractor used and maintained subcontractor relationships effectively.

8. INNOVATION: The contractor used leading edge information technology to solve problems and improve the efficiency and effectiveness of its business processes

9. COST CONTROL: The contractor was successful in containing costs and accurately forecasted costs.

10. PERFORMANCE ISSUES: The contractor “did not” fail to perform and achieved satisfactory results that did not result in termination of the contract or tasks.

11. PERFORMANCE ISSUES: The contractor received recognition for performance on projects of similar scope and complexity.

OVERALL PERFORMANCE:

YES NO

Overall, were you satisfied with the quality, timeliness, and cost effectiveness of the contractor’s work?

Given the choice, would you award a contract to this contractor again?

SUPPLEMENTAL COMMENTS FORM

1. Please provide the contract or contract numbers applicable to the ratings on the performance rating form. Please annotate (N/A) if not applicable.

2. Please provide a brief description of the scope of work performed on the contract or contracts rated on the performance rating form.

3. Please provide the total dollar value of the contract or contracts rated on the performance rating form.

4. Please provide the period of performance of the contract or contracts rated on the performance rating form.

5. Please explain why you would or why you would not award a contract to this contractor again.