Atch 5 PAST PERFORMANCE SURVEY.docx

Solicitation No. HTC711-20-R-XXXX

PAST AND PRESENT PERFORMANCE SURVEY

When Filled In This Document Is Source Selection Sensitive Information IAW FAR 3.104 & 2.101

REQUEST INFORMATION BE TYPED TO ENSURE READABILITY

A. CONTRACT INFORMATION FOR PRESENT OR PAST PERFORMANCE EFFORT BEING SUBMITTED FOR CONSIDERATION: (To be completed by Offeror)

Offeror’s Company Name: __________________________________________________________________

Address: ____________________________________________ Telephone Number: ________________________

Offeror Point of Contact/Email address: _____________________________________________________________

Project Title: __________________________________________________________________________________

Contract Number: ______________________________________________________________________________

Annual Dollar Amount: $_______________________________________________________________________

Total Dollar Amount of Overall Effort (to include all options) $__________________________________________

Place of Performance: ___________________________________________________________________________

Contract Start Date: __________________ Contract End Date (to include all options): _______________________

Number of Surveys Required to be Sent:________________ Response Rate Required:________________________

Response Rate Achieved:____________________________

Did the offeror perform services as the Prime Contractor or as a Sub-Contractor on the above referenced effort?

If performed as a Sub-Contractor, please provide a description of the tasks performed: __________________________________________________________________________________________________________________________________________________________________________________________

Annual Dollar Amount of Sub-Contracted tasks performed: $___________________________________________

B. RESPONDENT INFORMATION (To be completed by Respondent):

Note: If any of the information in Section A is incorrect, please make necessary changes.

Detailed Description of Services provided. Please include workload information to illustrate the level of effort for the referenced contract. (MUST BE COMPLETED BY RESPONDENT – NOT THE OFFEROR)

NOTE: Please provide a copy of the Performance Work Statement (PWS) or such portions of the PWS relevant to this acquisition.

Name of Respondent: _________________________________Title:______________________________________

Address: _____________________________________________________________________________________

Telephone Number: _____________________________________________________________________________

Fax Number: ______________________________ Email Address: _____________________________________

C. E-MAIL COMPLETED SURVEY FORM TO:

Nick Van Osdale/MSgt Mike Heth – E-mail nicholas.a.vanosdale.civ@mail.mil and michael.d.heth.mil@mail.mil.

When Filled In, This Document Is Source Selection Sensitive IAW FAR 2.101 and 3.104

NOTE: PPIRS may be reviewed. Although you may have filed a Contractor Performance Assessment Report (CPARS) for the contract listed, we would appreciate your response to this questionnaire because some of the questions relate to areas not covered by CPARS.

D. PERFORMANCE INFORMATION: (Please circle response. Do not “highlight” unless using Adobe. You may add comments as necessary to discuss specifics.)

Did the Contractor:

1. Successfully transition resources and personnel to ensure prompt contract start-up YES NO N/A and performance?

2. Successfully integrate between customer and contrator IT systems to enable YES NO N/A interfacing and triggering surveys to be sent?

3. Demonstrate the ability to produce accurate reports including data such as number YES NO N/A of surveys sent and received, scores, and trends?

4. Demonstrate the ability to generate and maintain the desired response rate(s) from YES NO N/A surveys sent?

5. Successfully protect customers’ personal data and identity? YES NO N/A

6. Successfully transfer all survey data and metadata when required? YES NO N/A

7. Successfully maintain a reliable IT system with minimal down-time? YES NO N/A

8. Perform contract requirements according to written directives? YES NO N/A

9. Was the contractor ever issued a letter of concern, cure, or show cause notice under YES NO the referenced contract? If yes, explain outcome below.

10. Would you award another contract to this contractor? If not, explain below. YES NO

11.

USING THE ABOVE DEFINITIONS, PLEASE RATE THE FOLLOWING:

1. Contractor’s quality of service: _______________________________________________

2. Contractor’s adherence to schedule: ___________________________________________

3. Contractor’s business relations: _______________________________________________

4. Contractor’s management of key personnel: _____________________________________

REMARKS

PLEASE PROVIDE A PARAGRAPH SUPPORTING YOUR ABOVE RATINGS. EXPLAIN THE CONTRACTOR’S GREATEST STRENGTHS AND/OR WEAKNESSES AND YOUR RATIONALE FOR WHY YOU WOULD OR WOULD NOT AWARD A FUTURE CONTRACT TO THEM.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

ATTACHMENT 5