J-11 Past Performance Questionnaire.docx

RFP: 75FCMC24R0010

Attachment J-11, Past Performance Questionnaire

PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

[COMPANY LETTERHEAD (Prime or subcontractor)]

Reference Name, Address and Contact information Date

SUBJECT: RFP: 75FCMC24R0010, Contact Center Operations

Dear _________________:

We are currently responding to the Centers for Medicare & Medicaid Services (CMS) Request for RFP number 75FCMC24R0010 (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: 75FCMC24R0010, Contact Center Operations

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 to:

Email PDF: brian.humes@cms.hhs.gov

Thank you for taking the time to complete the questionnaire.

INSTRUCTIONS FOR QUESTIONNAIRE RESPONSE

The information from this questionnaire will be utilized in accordance with the 1994 Federal Acquisition Streamlining Act, Section 1091 to evaluate the past performance of offerors.

The questionnaire is arranged by general performance areas, i.e., quality, cost control, schedule, management, and Utilization of Small Business. Each area consists of a few basic questions relating to that aspect of performance. We ask that you rate the contractor on a scale of 0 through 4 by circling the appropriate number. The following table describes the rating scale in more detail:

Rating Scale:

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

Finally, please sign your name and identify your position during your association with the referenced contract. Once completed, please e-mail your response to Brian Humes, Contract Specialist, brian.humes@cms.hhs.gov by (Offerors please include the date and time that Phase 2 proposals are due).

Category 0 or 1 responses will be referred to the contractor to permit rebuttal. Neither your name nor position within your organization will be divulged either during or after this survey has been completed.

PAST PERFORMANCE QUESTIONNAIRE

Solicitation No. _________________

Q1. What type of product(s)/services was provided under your contract?

Q2. What type of contract?

Q3. Competitive or non-competitive?

Q4. Total value of contract?

Q5. Period of Performance?

Ratings: Summarize contractor's performance and circle in the column on the right the number which corresponds to the performance rating for each rating category. See Rating Guidelines 0-Unsatisfactory 1-Marginal 2-Satisfactory 3-Very Good 4-Exceptional

Q1. Quality: Did the Offeror demonstrate the execution of quality efforts resulted in effective performance outcomes for work activities?

Q2. Cost Control: Did the Offeror demonstrate the ability to ensure costs were within budget?

Q3. Schedule: Did the Offeror demonstrate the ability to consistently meet project milestones and deliverables on time?

Q4. Management: Did the Offeror demonstrate a past track record of notifying its contractors/customers of problems, remaining flexible and reliable, and being responsive to contract requirements and recommending solutions? How well did the Offeror match the qualifications of the key position, as described in the contract, with the person that filled the key position? Did the Offeror support key personnel so they were able to work effectively?

Q6. Utilization of Small Business: Did the Offeror demonstrate and implement an effective and efficient small/small disadvantaged business subcontracting plan?

b. No

PRINT NAME: ____________________________________

SIGNATURE: ____________________________________

TITLE: ____________________________________

DATE: ____________________________________

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