Attachment 5 - Past Performance Questionnaire Survey.pdf

ATTACHMENT 5 - Past/Present Performance Reference Questionnaire Survey

Solicitation No.

75D30125R00073

PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE INSTRUCTIONS

Instructions: The 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 the 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 to complete the questionnaire;

c) Instructs the customer to return the completed questionnaire to the Contract Specialist:

David Santimaw, by email: zgm2@cdc.gov BEFORE JANUARY 9 2025, at 1:00 PM EDT.

Submit a copy of the customer’s cover letter with your business proposal to ensure receipt of questionnaire responses.

mailto:zgm2@cdc.gov

PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE

Solicitation No.

75D301-25-R-XXXXX

Name of Offeror:

Entity Name:

Reference Information Table

Business Name of Reference

Address of Reference

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/Unsatisfactor y

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

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

Of exceptional merit;

exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse

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:

2. 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.)?

3. 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?

4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

5. 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?

6. How would you rate the contractor’s overall performance?

7. Would you purchase services from this contractor again?

YES NO

Please provide any additional comments applicable to the contractor’s past performance:

EVALUATOR’S NAME (Signature): _____ ______________

TITLE OF EVALUATOR: _ ____

PHONE NUMBER: _____ ___ ___________ _

EMAIL ADDRESS: ___ _______

DATE: ___ _____