Appendix E - Past Performance Questionnaire (PPQ).pdf

SOURCE SELECTION SENSITIVE

NOT FOR PUBLIC RELEASE

APPENDIX E

RELEVANT PAST/PRESENT PERFORMANCE QUESTIONNAIRE

IHS National COVID-19 Critical Care Response Teams IDIQ

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

OFFEROR MAY FILL OUT THE SECTIONS 1 & 2 FOR THE CONVENIENCE OF THE EVALUATOR; HOWEVER, EVALUATOR SHALL VERIFY THAT THE INFORMATION PROVIDED BY THE OFFEROR IS COMPLETE AND

CORRECT.

SECTION 1: CONTRACT/ORGANIZATION IDENTIFICATION

A. Contractor/Organization’s Name:

B. DUNS Number (of the Contractor/Organization that the contract/grant/etc. was awarded to): ____________________

C. Contract/Grant/Cooperative Agreement/ IPA/MOU/MOA number: _____________________________

D. Contract type (Leave Blank if services were not performed under a contract): ________________________________________

E. Was this a competitive contract/grant/Cooperative Agreement or other Agreement? Yes No

F. Period of performance:

G. Initial cost: $

H. Current/final cost: $

I. Reasons for differences between initial cost and final costs:

J. Description of services provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone#:

D. Evaluator’s Email:

E. Number of years evaluator worked with organization on subject contract/grant/agreement, etc. ____

SECTION 4: EVALUATION

Please indicate your satisfaction with the organization’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

5 EXCEPTIONAL - The contractor/organization’s performance meets contractual/grant/agreement requirements and exceeds many (requirements) to the Government’s benefit. The performance was accomplished with few minor problems for which corrective actions taken by the contractor/organization were highly effective.

4 GOOD- The contractor/organizational’s performance meets contractual/grant/agreement requirements and exceeds some (requirements) to the Government’s benefit. The contractual/grant/agreement performance was accomplished with some minor problems for which corrective actions taken by the contractor/organization were effective.

3 ACCEPTABLE – The contractor/organizational’s performance meets contractual/grant/agreement requirements. The contractual/grant/agreement performance contained some minor problems for which corrective actions taken by the contractor/organization appear or were acceptable.

2 MARGINAL – Performance does not meet some contractual requirements. The contractual/grant/agreement performance reflects a serious problem for which the contractor/organization has not yet identified corrective actions or the contractor/organization’s proposed actions appear only marginally effective or were not fully implemented.

1 UNSATISFACTORY – Performance does not meet most contractual/grant/agreement requirements and recovery is not likely in a timely manner. The contractual/grant/agreement performance contains serious problem(s) for which the contractor/organization’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

The questions shown below should be tailored to the Factors/Subfactors of the contract/grant/Cooperative Agreement/MOA/MOU identified in Section 1.

Technical Performance 5 4 3 2 1 N

T1. Overall quality of the support services.

T3. Quality/integrity of data/report preparation and/or presentation efforts

T3. Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

Program Management 5 4 3 2 1 N

P1. Contractor/Organization was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

P2. Timeliness/effectiveness of contract problem resolution without extensive customer guidance

P3. Successfully responded to emergency and/or surge situations

P4. Quality/effectiveness of sub-contracted or sub-grantee efforts

P5. Contractor/Organization proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Transition/phase-in 5 4 3 2 1 N

T1. Contractor/Organization’s ability to smoothly transition resources and personnel.

T2. Contractor/Organization’s effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

Employee Retention/Attraction 5 4 3 2 1 N

E1. Ability to hire/apply a qualified workforce to this effort.

E2. Ability to retain a qualified workforce on this effort.

E3. Effectiveness of employee compensation towards quality of work.

Cost Performance 5 4 3 2 1 N

C2 Ability to meet forecasted costs and perform within contract/grant/agreement costs

C3 Ability to alert Government of unforeseen costs before they occur

2. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? (Leave blank if evaluation is for services completed under a grant, cooperative agreement, IPA, MOU or MOA).

Yes No

Default Convenience Pending Terminations

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc.).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor/organization in the future?

Overall, was the customer satisfied with the contractor/organization’s services? Did they meet or exceed the government’s expectation?

Evaluator’s Signature Date

Please return this completed questionnaire to:

Email Address: glenda.smith@ihs.gov & kenneth.truesdale@ihs.gov

Thank you for your prompt response and assistance!

mailto:reginald.lee@ihs.gov mailto:paul.premoe@ihs.gov

Thank you for your prompt response and assistance!