Attachment 12 - Past Performance Questionnaire (PPQ).pdf

PAST PERFORMANCE QUESTIONNAIRE

1 Source Selection Information - See FAR 2.101 and 3.104

To Whom It May Concern:

The Federal Bureau of Investigation intends to acquire a NATIONWIDE NETWORK OF CREDENTIALED MEDICAL PROVIDERS (MD, DO, NP and PA) for the Human Resources Division’s Fitness For Duty Medical Exam Program.

In order to accurately evaluate past performance, your assistance is requested in obtaining and verifying your company’s relevant past performance history on the attached Past Performance Rating Form. Please note that the company was directed to submit to you a copy of the Experience Narrative for your contract that it submitted as part of its quotation.

Upon completion of this form, please e-mail it to the Contract Specialist, Emily Moss at egmoss@fbi.gov. Please make the subject line of the e-mail read “HRD Medical Exam Services – Past Performance Questionnaire – Insert Evaluated Company’s Name.”

The following standards will be used in arriving at the rating:

Outstanding The Contractor’s performance exceeded customer expectations and was technically acceptable, providing significant features or benefits.

Satisfactory The Contractor met customer expectations or contract requirements and demonstrated an acceptable understanding of the requirements.

Unsatisfactory The Contractor’s performance was either marginal or did not meet customer expectations or contract requirements.

Other If the element is not applicable, indicate with “N/A.” If no data has been obtained or additional comments are provided, please note in this column.

2 Source Selection Information - See FAR 2.101 and 3.104

PAST PERFORMANCE RATING FORM

Name of Company Evaluated:

Address of Company Evaluated:

Contract Number: Period of Performance:

Contract Value: Contract Type:

Contracting Officer Name, Address, Telephone Number, and Email Address:

Type of Relevant Services Performed:

Name of Evaluator, Company / Agency, Address, Telephone Number, and Email Address:

Date Evaluation Provided:

3 Source Selection Information - See FAR 2.101 and 3.104

PERFORMANCE ELEMENT Outstanding Satisfactory Unsatisfactory

O t h e r

Program Management

1. OVERALL PROGRAM MANAGEMENT

(Example: Was the Contractor effective in integrating and coordinating all activities required to execute the contract? Did the Contractor appropriately assign responsibilities to its workforce?)

2. MANAGEMENT RESPONSIVENESS

(Example: Did Contractor management provide timely, complete, and quality problem identification? Did Contractor management provide effective business relations?)

3. MANAGEMENT OF PERSONNEL

(Example: Did the Contractor show an ability to select, retain, support, and replace personnel with the experience and expertise necessary to accomplish the Government’s requirement within schedule and budget?)

Technical Performance (Quality of Product or Service)

4. QUALITY OF TECHNICAL APPROACH

(Example: Were the provided services comprehensive, complete, and feasible? Did the provided services meet requirements and accommodate changing requirements.)

5. UNDERSTANDING OF REQUIREMENTS

(Example: Did the Contractor show an understanding of the scope of the requirements and an appreciation of the complexity of the requirements?

If applicable, did the Contractor effectively identify flaws, inconsistencies, and other inaccuracies in technical direction?)

6. ACCURACY OF THE QUOTER’S EXPERIENCE NARRATIVE

REGARDING THE CONTRACT

(Did the Contractor accurately state its performance under the contract?)

4 Source Selection Information - See FAR 2.101 and 3.104

Timeliness of Performance

7. EFFECTIVE AND EFFICIENT USE OF RESOURCES

(Example: Was the Contractor able to timely provide the number and type of personnel resources required to support the contract, and effectively train the personnel and maintain the required workforce throughout the term of the contract?)

8. TIMELINESS OF PERFORMANCE

(Example: Was the Contractor successful in planning and proposing realistic schedules, monitoring performance, completing work on time, and implementing corrections / changes in a timely manner?)

Quality / Customer Satisfaction

9. QUALITY OF PERFORMANCE / CUSTOMER SATISFACTION

(Example: Was the Contractor committed to customer satisfaction?)

10. BUSINESS BEHAVIOR

(Example: Was the Contractor reasonable and cooperative at the corporate and program levels in response to changes in technical direction?)

11. COMMUNICATION

(Example: Did the Contractor work and communicate well with Contracting Officer, Contracting Officer’s Representative, other contractors, subcontractors, and Government staff?)

Cost Control

12. COST CONTROL

(Example: Was the Contractor successful in planning and proposing realistic costs, monitoring performance, operating at or below budget, and implementing corrections / changes in a cost effective manner?)

For #13, PLEASE ANSWER “Yes” or “No”, as appropriate YES NO

13. GIVEN THE CHOICE, WOULD YOU DO BUSINESS WITH THIS

CONTRACTOR AGAIN?

ADDITIONAL COMMENT AREA

Please provide any additional comments regarding your performance element ratings in the space below.

Please add additional pages as necessary.