J.10_Revised_Past_Performance_Questionnaire.docx
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- Solicitation number
- 72066318R00016
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This document contains a past performance questionnaire and details of a federal contract opportunity from the United States Agency for International Development in Ethiopia. The past performance questionnaire seeks information about an offeror's performance on a prior project and must be completed and returned by the named referee by the specified due date. The federal contract opportunity is to provide technical services to support the development of Ethiopia's Electronic Health Information Systems activity. The objectives are to support health information technology systems and data repository at all levels, build a culture of data use, and build capacity and governance of the Ministry of Health's health information systems. Proposals from qualified organizations must be submitted in response to the solicitation number provided. The goal is to improve health services, quality of life, and build a sustainable healthcare system through use of data-driven decision making.
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ATTACHMENT J.10 - PAST PERFORMANCE QUESTIONNAIRE
Please fill out the following questionnaire as clearly and as objectively as possible. The information you provide will be used for source selection purposes. Offeror, please send the filled out questionnaire directly to the United States Agency for International Development (USAID) in Ethiopia by email to bteame@usaid.gov with a copy to caddis@usaid.gov and tgebremedhin@usaid.gov by no later than [time] Eastern Time on __________________, 2019.
SECTION A: (To be filled by the Offeror)
Offeror's Name: Click here to enter text.
Was the Offeror the Prime or Subcontractor on the project: Click here to enter text.
Project Name: Click here to enter text.
Project Scope/Description: Click here to enter text.
Primary Location (s) of Work: Click here to enter text.
Period of Performance: Click here to enter text. Dollar Value: Click here to enter text.
Name of Person Contacted: Click here to enter text. Phone No.: Click here to enter text.
Date Contacted: Click here to enter text. Employer: Click here to enter text.
Contact’s Role or Knowledge of the Project: Click here to enter text.
SECTION B: (To be filled by the contact person named in Section A above)
1. Please comment on your satisfaction with the Quality of product or service, including consistency in meeting goals and targets and rating.:
2. Please comment on the Timeliness of Contract Performance to include schedule, including the timeliness against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements and rating.: ______
3. Please comment on the Quality of Business relations, addressing the history of professional behavior and overall business-like concern for the interests of the customer, including the contractor’s history of reasonable and cooperative behavior: and rating.:
4. Please comment on the Contractor’s Ability to Cost control, including forecasting costs as well as accuracy in financial reporting and rating.:
5. Please comment on the contractor’s ability to comply with applicable regulations:
6. For prime offerors who are not small business concerns, their utilization of Small Business concerns as subcontractors, including efforts in achieving small business participation goals and rating.:
7. Please provide comments on Contractor’s Key Personnel and rating.:
Other Comments:
Signature of the Referee:
[END OF ATTACHMENT J.10]
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