Attachment_3_Past_Performance_Reference_Form-USAID_Indonesia.doc

PAST PERFORMANCE REFERENCE FORM

Subject:

Reference for [fill in offeror’s name] ________________

RE:

USAID/Indonesia Tuberculosis Private Sector – RFP No. 72049718R00012 Due Date:

June 26, 2018 at 14:00 Jakarta Time

Dear Referee, Your name has been provided by [fill in offeror’s name]___________________________as a past performance reference for their work that they have done for your organization, specifically as to the following activity/project:

[Offeror to provide Activity/Project Name and/or Contract/Agreement Reference No.]

We are seeking relevant past performance information for a USAID solicitation focused on Tuberculosis Private Sector Activity. The information that you provide will be used in the awarding of a Federal contract.

Please provide some brief feedback and select one of the ratings of the sub-criteria below. A table of the definitions for each of the ratings is included in the table below.

Please respond by June 26, 2018 at 14:00 Jakarta time, by sending this feedback directly to USAID Indonesia at proposals-indo@usaid.gov . Please label the Subject Line of the email as “[Name of Offeror – SOL-72049718R00012 - USAID TB PS - Past Performance Reference Form”.

If you have any additional questions or comments please feel free to email the Point of Contact: Albert Carrera, Contracting Officer via email at proposals-indo@usaid.gov .

Thanks for your time in responding. Your feedback is greatly appreciated in assisting the Technical Evaluation Committee (TEC) in its evaluation process.

Assessment Narrative

Please write no more than a paragraph on each of the assessment areas, which require concise writing on substantive issues related to contractor performance. (Imagine what you would like to know about this contractor if you were making a decision about whether to award a future contract.)

Assessment Rating

Based on the narrative, please rate the performance using the evaluation rating definition below. The rating should conform to the narrative.

Past Performance Evaluation

Question 1. Quality What is your assessment of the Contractor’s to provide quality products or services, including consistency in meeting goals and targets and cooperation and effectiveness of the Prime in fixing problems?

Quality

Narrative.

Question 2. Cost Control

What is your assessment of the Contractor’s ability to control cost, including forecasting costs as well as accuracy in financial reporting? (not applicable for Assistance, Firm-Fixed Price or Firm-Fixed Price with Economic Price Adjustment contracts).

Cost Control

Question 3. Schedule/Timeliness of performance

What is your assessment of the Contractor’s ability meet the schedule, including the timeliness against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance).

Schedule

Question 4. Management

What is your assessment of the Contractor’s ability to maintain professional behavior and overall business-like concern for the interests of the customer, including satisfactory business relationship to clients, initiation and management of several complex activities simultaneously, coordination among subawards and developing country partners, prompt and satisfactory correction of problems, and cooperative attitude in fixing problems?

Management

Question 5. Regulatory Compliance

What is your assessment of the Contractor’s ability to perform in accordance with award terms and conditions relating to applicable regulations and codes (financial, environmental, safety, and other reporting requirements)?

Regulatory Compliance

Question 6. Utilization of Small Business Concern (For Prime who are not small business)

What is your assessment of the Contractor’s ability to utilize small business concerns as subcontractors, and achievement on each individual small business goal stated within the award/or subawarding plan, including good faith effort if the goal was not achieved?

Utilization of Small Business

Name of Person Completing Questionnaire: _______________________________________

Agency/Organization: _______________________________________________________

Title: __________________________________ Phone: ______________________________

E-mail: ______________________________________________________________________

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