J.10_Past_Performance_Questionnaire.doc

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Attached to
Dose Reconstruction and Related Activities for Energy Employees Occupational Illness Compensation Program Act (EEOICPA)
Solicitation number
75D301-18-R-67998
Issued by

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J.10 Past Performance Questionnaire

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Past Performance Questionnaire Source Selection Sensitive Information Send completed questionnaire directly to Diane Meeder, CO at DMeeder@cdc.gov Centers for Disease Control and Prevention Solicitation: 75D301-18-R-67998

Evaluating Organization:
Contract Title:
Contractor Name:
Contractor Address:
City:
State:
Zip/Postal Code:

Additional or Alternate Contractor Name:

Contract Number:
Contract Type:
Contract Value:
Period(s) of Performance:

Requirement Description:

Ratings

Summarize contractor performance and check the number which corresponds to the rating for each rating category (See attached Rating Guidelines).

Quality of Product or Service

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good _4=Excellent

_5=Outstanding

Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Fixed-Price)

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Cost Control (2000 characters maximum):

Timeliness of Performance

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Timeliness of Performance (2000 characters maximum):

Business Relations

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Business Relations (2000 characters maximum):

Additional Info

Subcontracts (as applicable) Are subcontracts involved?

__Yes __No (Check one)

Comment on subcontracts (2000 characters maximum):

Contractor Key Personnel

Contractor Manager/Principal Investigator (name):

Comment on Contractor Manager/Principal Investigator (2000 characters maximum):

Contractor Key Person (name):

Comment on Contractor Key Person (2000 characters maximum):

Contractor Key Person (name):

Comment on Contractor Key Person (2000 characters maximum):

Small Business Subcontracting Plan (as applicable) Did the contractor make a good faith effort to comply with its subcontracting plan consistent with the goals and objectives, reporting and other aspects of the plan?

_Yes _No _N/A (Check one)

If this is a bundled contract, did the contractor meet the goals and objectives for small business participation?

_Yes _No _N/A (Check one)

Comments on Small Business Subcontracting Plan (2000 characters maximum):

Small Disadvantaged Business Goals (as applicable) Did the contractor make a good faith effort to comply with its subcontracting plan consistent with the goals and objectives, for small disadvantaged business (SDB) participation, monetary targets for SDB participation, and required notifications?

_Yes _No _N/A (Check one)

Comments on Small Disadvantaged Business Goals (2000 characters maximum):

Customer Satisfaction

Is/was the contractor committed to customer satisfaction?

_Yes _No (Check one)

Would you recommend the selection/doing business with this firm again?

_Yes _No (Check one)

Comments on Customer Satisfaction (2000 characters maximum):

Information Provided by:

Name:_______________________________________________________ Title:_________________________________________________________

Address:____________________________________________________________________________________________

Phone:__________________________________ Fax:____________________________________ E-mail Address:__________________________ Signature:_____________________________________________________

Date Information Provided: _____________________________

Questionnaire Completed by:

Name:_______________________________________________________

Title:_________________________________________________________

Address:____________________________________________________________________________________________

Phone:__________________________________

Fax:____________________________________

E-mail Address:__________________________

Signature:_____________________________________________________

Date Questionnaire Completed: _____________________________

Rating Guidelines

Quality of Product or Service

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Unsatisfactory
Non-conformances are jeopardizing the achievement of contract requirements, despite use of contracting organization’s resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.
Poor
Overall compliance requires significant contracting organization’s resources to ensure achievement of contract requirements.
Fair
Overall compliance requires minor contracting organization’s resources to ensure achievement of contract requirements.
Good
There are no, or very minimal, quality problems, and the Contractor has met the contract requirements.
Excellent
There are no quality issues, and the Contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the contracting organization.
Outstanding
The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Cost Control

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Unsatisfactory
Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of contracting organization’s resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.
Poor
Ability to manage cost issues requires significant contracting organization’s resources to ensure achievement of contract requirements.
Fair
Ability to control cost issues requires minor contracting organization’s resources to ensure achievement of contract requirements.
Good
There are no, or very minimal, cost management issues and the Contractor has met the contract requirements.
Excellent
There are no cost management issues and the Contractor has exceeded the contract requirements, achieving cost savings to the contracting organization.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Excellent".

Timeliness of Performance

Unsatisfactory
Delays are jeopardizing the achievement of contract requirements, despite use of contracting organization’s resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.
Poor
Delays require significant contracting organization’s resources to ensure achievement of contract requirements.
Fair
Delays require minor contracting organization’s resources to ensure achievement of contract requirements.
Good
There are no, or minimal, delays that impact achievement of contract requirements.
Excellent
There are no delays and the contractor has exceeded the agreed upon time schedule.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Business Relations

Unsatisfactory
Response to inquiries and/or technical, service, administrative issues is not effective. If not substantially mitigated or corrected it should constitute a significant impediment in considerations for future awards.
Poor
Response to inquiries and/or technical, service, administrative issues is marginally effective.
Fair
Response to inquiries and/or technical, service, administrative issues is somewhat effective.
Good
Response to inquiries and/or technical, service, administrative issues is consistently effective.
Excellent
Response to inquiries and/or technical, service, administrative issues exceeds expectation.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

PAGE

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