SOL-DOC 75ACF123R00004-Attachment 4 - Past Performance Questionnaire.docx

Past and Present Performance Questionnaire Solicitation FA7000-10-R-0036 Attachment 5

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

Company: Date Address:

1. We are contemplating offering a proposal for a solicitation from the United States Department of Health and Human Services (DHHS), Administration For Children and Families (ACF), Government Contracting Services (GCS). The solicitation is for legal services in support of ACF’s Office of Refugee Settlement (ORR) Unaccompanied Children (UC) Program, as articulated in the attached Performance Work Statement. This proposal requires that we provide past performance information. Please complete the attached past performance questionnaire and return it via email to:

CGSDRFPS@acf.hhs.gov

2. In order to ensure this questionnaire is considered, please forward this survey to arrive at the above email address, no later than XX XXX 2023. Upon completion, please notify my office that the survey has been accomplished.

Attachment 1: PWS Attachment 2: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION:

Contractor’s Name: __________________ Telephone Number: ____________________ Address: __________________________ __________________________ Point of Contact: ______________________

Project Title and Brief Description of Work: _____________________________________

Contract Number: ___________________ Overall Contract Value: ________

Contract Period or Dates of Performance: _______________________

Contractor performed as the Prime Contractor Sub-Contractor

B. POINT OF CONTACT INFORMATION:

Your Name: _____________________ Title: ____________________________

C. RETURN COMPLETED QUESTIONNAIRE VIA EMAIL TO:

CGSDRFPS@acf.hhs.gov

CONTRACTOR PERFORMANCE EVALUATION SURVEY

For each of the five criteria listed below, the rater must choose One (1) Adjectival Rating by checking the box, as applicable. At a minimum, for any rating that is checked Marginal or Unsatisfactory, please submit additional comments to substantiate the rating. Rater: Please submit completed form to CGSDRFPS@acf.hhs.gov

In the subject line, please include “PP ‘Contractor Name’ RFP No”.

1. QUALITY OF SERVICE

Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Satisfactory Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Marginal Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

ADDITIONAL COMMENTS:

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2. SCHEDULE

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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3. COST CONTROL

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

Not Applicable

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4. BUSINESS RELATIONS

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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5. MANAGEMENT OF KEY PERSONNEL

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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