Attachment 3 - Past Performance Questionnaire.docx

Past and Present Performance Questionnaire Solicitation FA7000-10-R-0036 Attachment 5

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Sample Cover Letter

Company: Date Address:

1. We are contemplating offering a proposal for a solicitation from the United States Department of Health and Human Services (DHHS), Administration For Children and Families (ACF), Government Contracting Services (GCS). The solicitation is for legal services in support of ACF’s Office of Refugee Settlement (ORR) Unaccompanied Children (UC) Program, as articulated in the attached Performance Work Statement. This solicitation requires that we provide past performance information. Please complete the attached past performance questionnaire and return it via email to: Emily.Graham@acf.hhs.gov and Drena.Vining@acf.hhs.gov.

2. In order to ensure this questionnaire is considered, please forward this survey to arrive at the above email address, no later than XX XXX 2024.

Attachment 1: Post Release Legal and Related Services (PRLS) for Unaccompanied Children Multiple Award Indefinite Delivery Indefinite Quantity (MA-IDIQ) Performance Work Statement (PWS).

Attachment 2: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

PART I

A. GENERAL INFORMATION:

Contractor’s Name: __________________ Telephone Number: ____________________ Address: __________________________ __________________________ Point of Contact: ______________________

Project Title:

Description of Work:

Dollar Value:

Contract Type:

Contract Period or Dates of Performance:

Performed as Prime or Sub Contractor:

Percentage of work completed as Prime or Sub Contractor:

B. POINT OF CONTACT INFORMATION:

Your Name: _____________________ Title: ____________________________

C. RETURN COMPLETED QUESTIONNAIRE VIA EMAIL TO:

Emily.Graham@acf.hhs.gov Drena.Vining@acf.hhs.gov

PART II

CONTRACTOR PERFORMANCE EVALUATION SURVEY

For each of the five criteria listed below, the rater must choose one (1) adjectival rating by checking the box, as applicable, please submit additional comments to substantiate the rating.

Rater: Please submit completed form to Emily.Graham@acf.hhs.gov and Drena.Vining@acf.hhs.gov.

In the subject line, please include “PP ‘Contractor Name’ RFP No. 75ACF124R00004”.

1. QUALITY OF SERVICE

Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Satisfactory Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Marginal Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

ADDITIONAL COMMENTS:

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2. SCHEDULE

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with 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 element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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3. COST CONTROL

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with 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 element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

Not Applicable

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4. BUSINESS RELATIONS

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with 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 element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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5. MANAGEMENT OF PERSONNEL

Performance meets contractual requirements and exceeds many to the Government’s benefit. The element being assessed was accomplished with 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 element being assessed was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the Contractor appear or were satisfactory

Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the Contractor has not yet identified corrective actions.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the Contractor’s corrective actions appear or were ineffective.

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