Attachment 3_Past Performance Questionnaire (PPQ).pdf

Attachment 3

Past Performance Questionnaire (PPQ)

A. INSTRUCTIONS

PAST PERFORMANCE QUESTIONNAIRE

The Department of Homeland Security (DHS), FEMA, recently released a

Request for Proposal for Consumable Medical Supplies. Offerors are asked to provide information on contracts similar in nature, size and complexity to the present requirement on which they had performed in the past. An offeror has submitted this to you as a reference for past performance. (See blocks

1 to 3 below). We need your opinion on how well the contractor performed on your contract(s). Please fill out the attached questionnaire and send it electronically to the Contracting Officer, Oneko Dunbar, at Oneko.Dunbar@fema.dhs.gov and the Contract Specialist, Marcia Irizarry at Snyder Marcia.IrizarrySnyder@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. 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 Oneko.Dunbar@fema.dhs.gov and the Contract Specialist at

Marcia.IrizarrySnyder@fema.dhs.gov.

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) Satisfactory: Based on the offeror’s relevant past performance record, it is likely that the offeror will successfully perform the required effort.;

2) Unsatisfactory: Based on the offeror’s past performance record, which is deemed not relevant, it is not likely that the offeror will successfully perform the required effort.

3) Neutral: No relevant performance record is identifiable upon which to base a meaningful performance rating. A search was unable to identify any relevant past performance information for the offeror or subcontractors. This is neither a negative nor positive assessment.

mailto:Rashurn.Harrison@fema.dhs.gov mailto:Eric.Walker@fema.dhs.gov mailto:Rashurn.Harrison@fema.dhs.gov mailto:Ian.lipscomb@fema.dhs.gov

B. 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

Performance Element Neutral Satisfactory Unsatisfactory

1. QUALITY OF SERVICES:

The contractor provided high quality of service.

2. CUSTOMER SATISFACTION:

The contractor exhibited a commitment to customer satisfaction and achieved customer satisfaction.

3. TIMELINESS OF

PERFORMANCE AND

COMPLETION OF THE

CONTRACT: The contractor planned and proposed realistic schedules, successfully monitored performance and completed work on time and safely.

Yes No

1. Given the choice would you do business with this contractor again?

Supplemental Comment Form

Please provide any additional comments regarding your performance element ratings in the appropriate spaces below. Please add additional pages as necessary.

Performance Element #1, Quality of Services:

Performance Element #2, Customer Satisfaction:

Performance Element #3, Timeliness of Performance and Completion of the Contract