Attachment_D.3_Past_Performance_Questionaire.docx

75FCMC19R0034

Past Performance Questionnaire Attachment D.3

PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

[COMPANY LETTERHEAD (Prime or subcontractor)]

Reference Name, Address and Contact information Date

SUBJECT: RFQ #190750 – CMS Organization Development, Executive Coaching, & Leadership Training

Dear _________________:

We are currently responding to the Centers for Medicare & Medicaid Services (CMS) Request for Quote number 190750 (as a subcontractor to______ (If applicable)). The purpose of this contract is to perform ____________________________________________.

There is an increased emphasis on past performance in the federal source selection process. The CMS is requesting that customers and clients of Offerors provide the information as described within the attached questionnaire and return it to them for evaluation. We have identified you as one of our references and respectfully request that you complete and sign the attached questionnaire and then return it to CMS.

Questionnaires are due to CMS no later than ____________ (to be filled in by Offeror); however, we would appreciate an earlier response if at all possible.

We sincerely appreciate your cooperation in this matter.

Sincerely, Reference Name Title

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop B3-30-03 Baltimore, Maryland 21244-1850

Office of Acquisition and Grants Management

SUBJECT: RFP 75FCMC19R0034 - Quality, Safety, and Oversight (QSOG) Infection Prevention and Control Consultant

To Whom It May Concern:

The Centers for Medicare & Medicaid Services (CMS) very much appreciates your time and thoughtfulness in completing the attached questionnaire. The information obtained from this questionnaire will be utilized to evaluate the past performance of Offerors/Contractors who wish to be awarded a contract with CMS.

CMS may engage in exchanges with offerors regarding past performance information submitted to CMS in connection with the subject solicitation. If CMS engages in such exchanges, CMS may share information disclosed in this survey with the Offeror to whom it pertains, as permitted or required by the FAR. Otherwise, CMS will only share information from this survey outside the agency pursuant to a protective order or as otherwise required by law

The questionnaire is arranged by the following performance areas: customer service, financial management, operational excellence, innovations and general performance. Each area consists of a few basic questions relating to these aspects of performance with regard to the Offeror/Contractor with which you worked. Please complete the questionnaire as indicated on the form.

Finally, please sign your name and identify your position during your association with the referenced Offeror/Contractor. Once completed, please submit the questionnaire in one of the following manners:

Email PDF (Preferred): paul.judd2@cms.hhs.gov

Thank you for taking the time to complete the questionnaire.

Sincerely, /s/

PAST PERFORMANCE QUESTIONNAIRE

CMS Solicitation No. RFQ #190750 –CMS Organization Development, Executive Coaching, & Leadership Training

(Company Being Evaluated) (Offeror)

Name of Contracting Activity:____________________________________________________ Brief Description of Work: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contract Type:________________________________________________________________________ Total Contract Value:___________________________________________________________________ Performance Period:____________________________________________________________________ Please complete the following questionnaire about the Offeror/Contractor and indicate your responses in the blocks or columns, as appropriate. Numerical ratings are as indicated in the Rating Scale below. Other Ratings are as indicated in each block.

Rating Scale:

We request that you justify each of your ratings with a comment. Please be as specific in your comment as possible, especially in situations that warrant very high or very low ratings. Use extra pages as necessary or expand the form electronically as needed.

CUSTOMER SERVICE

Q1. How well did the contractor work with project/contracting officers?

(prompt notification of problems - reasonable, cooperative, flexible - pro-active - responsive to contract requirements - recommended solutions) Rating:

Comments:

Q2. How would you describe the contractor’s commitment to customer satisfaction?

(how well did the contractor interface with the end user of the product/service)

Rating:

Comments:

Q3. How well did the contractor communicate deviations in program goals? Did the contractor effectively and timely notify the project/contracting officer when there were possible problems with meeting deliverables, quality standards or project milestones?

FINANCIAL MANAGEMENT

Q4. How well did the contractor control costs?

(within budget (over/under target costs) - contractor provided current, accurate and complete billings - relationships of negotiated costs to actuals - cost efficiencies)

Rating:

Comments:

Q5. If there was a cost overrun (delivery delays), in your opinion, how much of the overrun/delay was attributable to contractor mismanagement?

a. All

b. Most

c. Half

d. Little

e. None

f. Not Applicable Comments:

Q6. Do you believe the contractor can be relied upon to control the cost of performance?

a. Yes

b. No

c. Uncertain Comments:

OPERATIONAL EXCELLENCE

Q7. How was the contractor’s quality of products/services?

(compliance with contract requirements - accuracy of reports submitted - technical excellence/ appropriateness of personnel)

Rating:

Comments:

Q8. How well did the contractor comply with timeliness?

(did contractor meet interim milestones - reliable - responsive to technical direction - met all delivery schedules on time)

Rating:

Comments:

Q9. Based on your experience with this contractor, do you think it can be relied upon to deliver quality products/services by a specific delivery date?

a. Yes

b. No

Comments:

Q10. How cooperative was the contractor when technical problems were encountered during the performance of the contract?

a. Highly cooperative

b. Moderately cooperative

c. Slightly cooperative

d. Slightly uncooperative

e. Moderately uncooperative

f. Highly uncooperative

g. No opinion

Comments:

Q11. How frequently did you have to direct the contractor to re-perform the service because it had been performed unsatisfactorily the first time?

a. None

b. Occasionally

c. Often

d. Always, or almost always

Comments:

INNOVATIONS

Q12. How well did the contractor develop and continually refine its internal business processes to improve the quality of the work delivered on the contract?

If the contractor did incorporate business processes changes, what was the impact of those changes on the daily operation?

GENERAL PERFORMANCE

Q13. Was this contractor’s performance generally satisfactory?

a. Yes

b. No Comments:

Q14. Would you hire this contractor again?

a. Yes

b. No

Comments:

Q15. Would you recommend this contractor to others?

a. Yes

b. No

Comments:

Q16. Any other comments regarding the contractor’s performance?

Comments:

Agency/Company COMPLETING Questionnaire

Agency/Company Name: ___________________________

Address: ___________________________

Name: ___________________________ Telephone No.: ________________________

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