Attchmnt_1-Past_Performance_Forms_(1Apr14).docx

ATTACHMENT 1--PAST PERFORMANCE FORMS

RFQ # AB-133M-14-RQ-0031

INSTRUCTIONS: This form is to be used to document past performance for projects similar in size and nature to the requirements of this RFQ.

Offeror/Contractor: Please complete Part 1 and provide each reference/evaluator with the form.

Reference/Evaluator: Please complete Part 2 and provide your candid responses. The information that you provide will be used in the evaluation of the offeror/contractor for the potential award of a federal contract or agreement. Therefore, it is important that your information be as factual, accurate, and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this questionnaire to the person who does.

PART 1: (TO BE COMPLETED BY THE OFFEROR/CONTRACTOR)

A. NAME OF COMPANY BEING EVALUATED:

B. NAME/ADDRESS OF COMPANY PROVIDING EVALUATION INFORMATION:

Company Name:

Evaluator's Name and Title:

Address:

Telephone No.: E-mail Address:

C. PROJECT INFORMATION

(Under Work Description, include similarities/relevance to solicitation project AND a description of work performed.)

Contract No.:

Project Title/Location:

Work Description:

Contract Type:

Original Contract Price:

Final Contract Price:

Original Completion Date:

Forecasted/Actual Completion Date:

Work was with: Commercial ____ Fed. Gov't ____ Local/City/State Gov't ____

PART 2: EVALUATION (INFORMATION TO BE COMPLETED BY THE EVAULATOR RESPONDING FOR THE OFFEROR):

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (e.g., problems due to causes outside the contractor's control). An individual within your organization that is knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's (offeror's) performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

Past performance provided will be assigned a risk rating as outlined below:

The offeror provided exceptional performance in the area being evaluated and there were no weaknesses or deficiencies identified.

The offeror has a very good performance record in the area being evaluated. Only minor weaknesses or deficiencies were identified.

The offeror’s performance was satisfactory but not otherwise exemplary.

Weaknesses or deficiencies were identified in their performance.

The offeror has a marginal performance record and one or two significant weaknesses or deficiencies were identified.

The offeror has a poor performance record. Several significant weaknesses or deficiencies were identified, which lead to a material failure in meeting the contract terms and conditions.

When responding to the questions listed, circle or highlight the letter that most accurately describes the contractor's performance or situation. Any Exceptional, Marginal, or Unsatisfactory rating assessed by the customer on individual elements or overall rating assigned on the past performance questionnaire shall include an explanatory narrative to be provided in the remarks block. These narratives need not be lengthy, just adequately detailed to support evidence of the specific ratings noted above. Failure to provide information supporting the assigned rating may result in a lower rating designation than that assigned by the customer. If a question is not applicable, indicate with N/A. If you circle a Yes or No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly. Your time and effort in providing this information is vitally important and is greatly appreciated.

CONTRACTOR QUALITY AND PERFORMANCE

1. Contractor's compliance with contractual terms and conditions. E VG S M U N/A

2. Contractor's ability to meet minimum requirements specified for performance. E VG S M U N/A

3. Overall rating of contractor's quality of product and performance. E VG S M U N/A

4. Ability to meet forecasted costs and perform within established contract pricing. E VG S M U N/A

5. Contractor compliance with Health Insurance Portability and Accountability E VG S M U N/A Act (HIPPA)/confidentiality requirements.

BUSINESS RELATIONS

1. Contractor's ability to correct problems and prevent or mitigate potential E VG S M U N/A problems in a timely manner.

2. Contractor's ability to use effective approaches and provide technical E VG S M U N/A expertise and resources to solve contract problems.

3. Contractor's overall rating of customer satisfaction. E VG S M U N/A

MANAGEMENT OF KEY PERSONNEL

1. Contractor's ability to meet appropriate staffing levels with qualified E VG S M U N/A personnel in order to meet requirements.

2. Rate the contractor's ability to replace key personnel in a timely fashion. E VG S M U N/A

3. Overall rating of contractor's management of key personnel. E VG S M U N/A

4. Contractor was reasonable and cooperative in dealing with your staff (including the E VG S M U N/A ability to successfully resolve disagreements/disputes).

CONTRACTUAL CONSIDERATIONS

1. Has an election ever been made not to exercise an option or continue relations YES* NO due to contractor's poor performance?

2. Has a Contract Discrepancy Report ever been issued? YES* NO

3. Has this contract been partially or completely terminated for default or YES* NO convenience? Partially _________ Completely ___________

4. Overall rating of contractor's performance. E VG S M U N/A

5. Would you contract with or hire this contractor again? YES NO*

NOTE: For any Exceptional, Marginal, or Unsatisfactory ratings assessed by the customer when completing this form, please include an explanatory narrative in the “remarks” block below.

*REMARKS

Are you aware of other relevant past efforts performed by this company? If yes, please provide the name and telephone number of a point of contact.

Thank you for your prompt response and assistance!

Please complete this questionnaire and return no later than close of business on 30 April 2014 directly to Contract Specialist Angela Royster by email, fax, or mail to:

Email: angela.royster@noaa.gov (Please include “Maritime Medical Support Services, AB-133M-14-RQ-0031: Past Performance” in subject line.)

Fax: (206) 527-0335 (Please include “Maritime Medical Support Services, AB-133M-14-RQ-0031: Past Performance” and Attn: Angela Royster on cover page. Please email Contract Specialist Angela Royster at angela.royster@noaa.gov letting her know you submitted via fax machine, being sure to include “Maritime Medical Support Services, AB-133M-14-RQ-0031: Past Performance” in the subject line of the email.)

Mailing Address: NOAA, Western Acquisition Division Attn: Angela Royster, Contract Specialist 7600 Sand Point Way NE Bldg. 1, WC3 Seattle, WA 98115-6349

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