ATTACHMENT E -Revised Past Performance Questionairre.pdf

ATTACHMENT E – PAST PERFORMANCE QUESTIONNAIRE LETTER

Date:

Dear Client:

We are currently responding to the Health Resources and Services Administration (HRSA) Solicitation No. 75R60220R00001 entitled, Ending the HIV Epidemic: Pre-Exposure Prophylaxis (PrEP) Implementation and Dissemination. The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

ATTN: Carolyn C. Taylor HRSA/Office of Acquisitions Management and Policy 5600 Fishers Lane, Room 14W29 Rockville, Maryland 20857 Phone: 301-443-6508 Email: ctaylor@hrsa.gov

Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above address no later than February 13, 2020, 2:00 p.m. or via email at ctaylor@hrsa.gov.

We thank you for your prompt response in this matter.

Sincerely, (To be signed by Offeror)

Ending the HIV Epidemic: Pre-Exposure Prophylaxis (PrEP) Implementation and Dissemination Solicitation# 75R60220R00001

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

FOR: ________________________________________________________________________

Name of Company

PLEASE RETURN COMPLETED SURVEY TO:

HRSA/OAMP

ATTN: Carolyn C. Taylor 5600 Fishers Lane, Room 14W29 Rockville, Maryland 20857 Email: ctaylor@hrsa.gov

PLEASE FILL IN THE FOLLOWING:

Your Name: ____________________________ Your Agency:________________________ Address:___________________________________________________________________ Phone Number:_________________________ Fax :________________________________ Signature of Person Completing Survey:___________________________________________ Contract Number/Solicitation Number: ____________________________________________

YOUR ROLE IN THIS CONTRACT (circle one)

Contracting Officer’s Representative Contracting Officer Contract Specialist

Approximate Percentage of Work Competed by Subcontractors: ______ % General Description or work or Title of Contract: _____________________________________________

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Standard

Contractor Performance Report

Evaluation Type: Solicitation-Past Performance Evaluation Factor Solicitation No.:

Evaluating Organization: Reporting Period: From to Contracting Office: Contract Number: Order Number:

Contractor Name: Contractor Address:

DUNS: City: State:

Additional or Alternate Contractor Name:

Zip/Postal Code: Country:

TIN: Industrial Code (NAICS): Commodity Code: Contract Type:

Contract Award Date: Contract Expiration Date: Contract Value:

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 Government 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)

Government Comments for Cost Control (2000 characters maximum):

Timeliness of Performance

Government Comments for Timeliness of Performance (2000 characters maximum):

Business Relations

Government Comments for Business Relations (2000 characters maximum):

Additional Info

Subcontracts

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):

Customer Satisfaction

Is/was the contractor committed to customer satisfaction? _Yes _No (Check one)

Would you recommend the selection of this firm again? _Yes _No (Check one) –

Comments on Customer Satisfaction (2000 characters maximum):

Admin Info

Project Officer/COR Name:

Phone:

Fax:

E-mail Address:

Contracting Officer:

Name:

Phone:

Fax:

E-mail Address:

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 Agency 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 Agency resources to ensure achievement of contract requirements.

Fair Overall compliance requires minor Agency resources to ensure achievement of

Good There are no, or very minimal, quality problems, and the Contractor has met the

Excellent There are no quality issues, and the Contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government.

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 Agency 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 Agency resources to ensure achievement of contract requirements.

Fair Ability to control cost issues requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, cost management issues and the Contractor has met the

Excellent There are no cost management issues and the Contractor has exceeded the contract requirements, achieving cost savings to the Government.

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 Agency 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 Agency resources to ensure achievement of contract requirements.

Fair Delays require minor Agency 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

Good Response to inquiries and/or technical, service, administrative issues is consistently

Excellent Response to inquiries and/or technical, service, administrative issues exceeds Government 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".