Attachment 2.docx
DOCX document 24 KB Posted
- Attached to
- Simulation Model - Social Determinants of Health
- Solicitation number
- 75D301-23-R-72632
About this file
This document contains a past/present performance reference questionnaire template for a firm-fixed-price contract solicitation issued by the Centers for Disease Control and Prevention. Offerors are required to provide three business references to complete the questionnaire evaluating the offeror's past and present performance on delivery schedules, business practices, quality standards, compliance with contract terms, customer satisfaction, and overall performance. References will also indicate whether they would utilize the offeror's services again. The solicitation number is 75D301-23-R-72632 and seeks proposals for a simulation model addressing social determinants of health. No further details are provided on deliverables, pricing, or the period of performance.
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Other files
| File | Type | Posted |
|---|---|---|
| 75D301-23-R-72632 Rev. 1.doc | DOC document | |
| 75D301-23-R-72632 Rev. 1.doc | DOC document | |
| Government Answers to Questions Submitted.pdf | ||
| 75D301-23-R-72632.doc | DOC document |
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Text version
ATTACHMENT J.2
PAST/PRESENT PERFORMANCE REFERENCE INSTRUCTIONS
Instructions: OFFEROR shall complete the PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE Reference Information Table themselves for the attached questionnaire, identifying the name and other pertinent information for each of your three (3) selected business references. This table, including the name of the offeror, shall be filled out completely by the offeror BEFORE sending it to the customers to respond to the questions. This will ensure the accuracy of the information being provided.
Send the attached questionnaire to each of the customers with a cover letter that:
(a) authorizes the selected customers to discuss the offeror’s performance under the applicable contract with the contracting officer;
(b) requests the customer complete the questionnaire;
(c) instructs the customer to return the completed questionnaire to the Contracting Officer, Adam Dwyer, by email:
Email: oel3@cdc.gov
Submit a copy of the customer’s cover letter with your business proposal to ensure receipt of questionnaires’ responses.
PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE
Name of Offeror:
Reference Information Table
| Business Name of reference & address |
| Point of Contact |
| Phone number |
| E-mail address |
| Contract or Purchase Order Number |
| Dollar Value |
| Period of Performance |
| Description of Services Performed |
| Explain any problems and resolutions |
| P/U |
| S |
| G |
| VG |
| E |
| N |
Poor/ Unsatisfactory
| Satisfactory |
| Good |
| Very Good |
| Excellent |
| Neutral |
Does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas; deficiencies in one or more areas which adversely affect overall performance.
Meets or slightly exceeds minimum acceptable standards; adequate results; reportable deficiencies with identifiable, but not substantial, effects on overall performance.
Effective performance; fully responsive to contract requirements; reportable deficiencies, but with little identifiable effect on overall performance.
Very effective performance; fully responsive to contract requirements; contract requirements accomplished in a timely, efficient, and economical manner for the most part; only minor deficiencies with minimal effect on overall performance.
Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall performance.
No record of relevant past performance or past performance information is not available
1. How would you rate the contractor’s compliance with the delivery schedule / performance milestones?
Comments:
P/U|_| S|_| G|_| VG|_| E|_| N|_|
1. How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?
1. How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service?
1. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?
1. How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?
1. How would you rate the contractor’s overall performance?
7. Would you purchase services from this contractor again?
Comments:
|_| YES |_|NO
Please provide any additional comments applicable to the contractor’s past performance:
EVALUATOR’S NAME: ___________________________________________
TITLE OF EVALUATOR:___________________________________________
DATE: _________________
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