Attachment 2b Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE LETTER

Date:

Dear Client:

We are currently responding to the Maternal and Child Health Bureau (MCHB) Solicitation No: Solicitation #75R60226R00026, entitled “Evidence Reviews of Newborn Screening Genetic Conditions” for MCHB. The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to SAMHSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

Email: SHorton@hrsa.gov with copy to evanabsher@hrsa.gov RFP#75R60226R00026 Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above email address no later than the closing date of the Request for Task Order Proposal on September 14, 2026, at 3:00 PM EST.

We thank you for your prompt response in this matter. Sincerely, (To be signed by offeror) Attachment 2b- Past Performance Questionnaire MCHB IDIQ Solicitation #75R60226R00026

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

For: Name of Company Please Return Completed Survey To:

Email: SHorton@hrsa.gov Please Fill In The Following:

Your Name: Your Agency: Address: Phone Number: Fax Number:

Signature of Person Completing Survey:

Contract Number / Solicitation Number:

Your Role In This Contract (circle one) Project Officer Contracting Officer Contract Specialist Approximate Percentage of Work Competed by Subcontractors: % General Description or work or Title of Contract:

Attachment 2b- Past Performance Questionnaire

Standard Contractor Performance Report

Contract Type:

Contract Number / Order Number:

Contractor Name:

Contract Award Date:

Contract Expiration Date:

Contract Value:

Supplies or Services:

Ratings

Summarize contractor performance and check the selection which corresponds to the rating for each rating category (See attached Rating Guidelines). Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Quality of Product or Service:

Government Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Firm Fixed Price):

Timeliness of Performance:

Business Relations:

Additional Info Subcontracts:

Are subcontracts involved? Yes No (Check one) Comment on subcontracts (2000 characters maximum):

Customer Satisfaction:

Is / was the contractor committed to customer satisfaction? Yes No (Check one) Would you recommend the selection of this firm again? Yes No (Check one) Comments on Customer Satisfaction (2000 characters maximum):

Admin Info Project Officer / COR Name:

Phone:

Fax:

E-mail Address:

Contracting Officer:

Name:

Phone:

Fax:

E-mail Address:

Rating Guidelines Quality of Product or Service

Unsatisfactory Non-conformances are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

Poor Overall compliance requires significant Agency resources to ensure achievement of contract requirements.

Fair Overall compliance requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, quality problems, and the contractor has met the contract requirements.

Excellent There are no quality issues, and the contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Cost Control

Unsatisfactory Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.

Poor Ability to manage cost issues requires significant Agency resources to ensure achievement of contract requirements.

Fair Ability to control cost issues requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, cost management issues and the contractor has met the contract requirements.

Excellent There are no cost management issues and the contractor has exceeded the contract requirements, achieving cost savings to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Excellent".

Timeliness of Performance

Unsatisfactory Delays are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.

Poor Delays require significant Agency resources to ensure achievement of contract requirements.

Fair Delays require minor Agency resources to ensure achievement of contract requirements.

Good There are no, or minimal, delays that impact achievement of contract requirements.

Excellent There are no delays and the contractor has exceeded the agreed upon time schedule.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Business Relations

Unsatisfactory Response to inquiries and/or technical, service, administrative issues is not effective. If not substantially mitigated or corrected it should constitute a significant impediment in considerations for future awards.

Poor Response to inquiries and/or technical, service, administrative issues is marginally effective.

Fair Response to inquiries and/or technical, service, administrative issues is somewhat effective.

Good Response to inquiries and/or technical, service, administrative issues is consistently effective.

Excellent Response to inquiries and/or technical, service, administrative issues exceeds Government expectation.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".