Attachment 3 - Past Performance Information Form - 123A94-24-Q-0018.docx
DOCX document 31 KB Posted
- Attached to
- Portable Audiometric Testing-Device Services
- Solicitation number
- 123A94Q0018
About this file
This document is a Past and Present Performance Questionnaire related to a federal contract opportunity for Portable Audiometric Testing-Devices and Services (PATS) issued by the USDA/FSIS. The questionnaire is requesting a performance evaluation from the respondent for the contractor listed, who is being considered for this contract. The key details include the contractor's name, contract information, a list of 14 performance criteria to be rated on a scale from Exceptional to Unsatisfactory, and questions regarding any default or cure notices and the respondent's willingness to award another contract to this contractor. The related federal contract opportunity is a Request for Quotation (RFQ) for PATS, with a 30-day phase-in period anticipated to start on June 1, 2024, a base period of one year, and four 12-month option periods. The contract will be a firm-fixed-price contract. Offers are due on May 17, 2024, and questions regarding the solicitation are due by May 3, 2024.
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Past and Present Performance Questionnaire
SUBJECT: Request for Past Performance Evaluation TO:
You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a Portable Audiometric Testing-Device and Services (PATS) contract for USDA/FSIS.
Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at .
Please submit completed questionnaire to the Government Contract Specialist identified on the attached questionnaire.
Contractor Signature
1 Attachment: Past and Present Performance Questionnaire
A. GENERAL INFORMATION:
Please correct any information below known to be inaccurate
| Contractor’s Name: | Address: Telephone Number: |
| Fax Number: | Point of Contact: |
Project Title and Brief Description of Work*:
Contract Number Provided by Offeror: Dollar Amount: $
Contract Period or Dates of Performance Provided by Offeror*:
* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.
Contractor performed as the Prime Contractor Sub-Contractor Key Personnel
B. RESPONDENT INFORMATION:
| Name of Respondent: | Title: | ||
| Address: | Telephone Number: | Fax Number: | Email Address: |
C. SEND COMPLETED SURVEY FORM TO (E-mail is Preferred Method):
Reggie Brown
USDA/FSIS
Reginald.brown@usda.gov Karen Petty
USDA/FSIS
Karen.petty2@usda.gov
D. PERFORMANCE INFORMATION:
Choose the appropriate letter on the scale (E, G, S, M, U, N) that most accurately describes the contractor’s performance or situation or N/A if performance in this area is not applicable to the effort addressed.
PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.
| E |
| G |
| S |
| M |
| U |
| N |
| Exceptional |
| Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Neutral |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective |
| Performance meets contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s corrective actions appear only marginally effective or were not fully |
implemented
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear to be or were ineffective |
| Performance was not observed or applicable to the current effort being reported against. |
CONTRACTOR’S NAME: CONTRACT #:
Place an “X” in the appropriate column using the definitions matrix above.
| Contractor Performance or Situation |
| E |
| G |
| S |
| M |
| U |
| N |
| N/A |
| 1. |
| How well did the contractor implement an orderly transition from the incumbent contractor? |
| 2. |
| How well did the contractor comply with contractual terms and conditions including the preparation and timely/accurate submission of any required documents? |
| 3. |
| How well did the contractor attract and retain qualified and fully |
trained personnel at all levels within their organization to ensure contract compliance?
| 4. |
| How well does the contractor’s organization provide the necessary |
manning, training, equipment, and supplies to meet contractual requirements?
| 5. |
| How would you rate the contractor’s critical key management and technical staff in terms of expertise, knowledge and qualifications? |
| 6. |
| Rate contractor’s ability to respond to workload fluctuations, e.g. budgetary fluctuations that resulted in increased or decreased activities. |
| 7. |
| How willing was the contractor to improve and correct |
noncompliance issues or concerns?
8.
9.
10.
11.
12.
| 13. |
| Was the contractor ever issued a default, cure or show cause notice, Notice of Violation under the referenced contract? If yes, explain outcome in “remarks.” |
| YES NO |
| 14. |
| Would you award another contract to this contractor? If not, explain in “remarks.” |
| YES NO |
| 15. |
| If a Government Contract, is the contractor rated in CPARS? |
| YES NO |
Remarks (provide detail regarding unfavorable ratings):
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