ATT2_PPQSol.pdf

NATIONAL GUARD BUREAU

UNITED STATES PROPERTY AND FISCAL OFFICE

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

Performance Assessment Questionnaire – Cover Letter

SUBJECT: Offeror Past Performance Assessment in Support of Request for Proposal (RFP) W9127P21R0002 Professional Services for the State Surgeon’s Office

Dear Sir/Ma’am, The US Army Virgin Islands National Guard is currently conducting a competitive source selection to evaluate offerors on the subject RFP. As part of this evaluation, we have requested that the offerors provide information about their past performance on same or similar federal, state, or local government or commercial contracts as compared to the North American Industry Classification System [NAICS] Code 621399 Office of all other Misc Health Practitioners and 621210 Offices of Dentists with a size standard of $8,000,000. You have been identified as the point of contact cited on the enclosure.

Your assessment of their performance is extremely valuable to our evaluation.

Please complete the enclosure and return to the VI Purchasing and Contracting Office at RR2, Box 9700, Kingshill, VI 00851, no later than 15 days after receipt of request or before 15 JUL 2021, whichever occurs first. Submit your completed questionnaire to Donna Prock.

Your cooperation is greatly appreciated. Questions may be directed to the undersigned at 340-712-7856 or 417-840-1546 or donna.r.prock.mil@mail.mil.

Sincerely, Donna R. Prock Contracting Officer mailto:donna.r.prock.mil@mail.mil

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

Performance Assessment Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. 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 and notify the Contracting Officer. Please return the completed Questionnaire to the Contracting Officer identified in the cover letter within the stated timeframe.

Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements.

Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent) *Note: rationale is required for each response.

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: _________________________________________________________

B. Effectiveness of Project Management (to include use and control of subcontractors).

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: __________________________________________________________

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

C. Timeliness of Performance for Services and Product Deliverables.

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: __________________________________________________________

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

Substantial Confidence Satisfactory Confidence Limited Confidence No Confidence

Rationale: __________________________________________________________

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Substantial Confidence Satisfactory Confidence

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

Limited Confidence No Confidence

Rationale: __________________________________________________________

F. General Comments. Provide any other relevant performance information.

Comments: _________________________________________________________

G. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Point of Contact (Name): __________________________________________ Telephone Number: ______________________________________________

H. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

FOR THE U.S. VIRGIN ISLANDS

RURAL ROUTE 2, BOX 9200

KINGSHILL, VI 00850-9731

Please return this completed Questionnaire to the Contracting Officer identified in the cover letter.

Thank you for your assistance.

PART III. RETURN INFORMATION