Attachment 4 Past Performance form.docx

RFP # 19AQMM25R0201 – ATTACHMENT 4

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104

WHEN COMPLETED, FOR OFFICIAL USE ONLY

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

Offeror Instructions: Complete Transmittal Letter and Section 1 of the Past Performance Questionnaire (PPQ) and send to the assessor(s). Ensure assessor returns a copy of the completed questionnaire to the Department of State POC identified below prior to the solicitation closing date and time.

Assessor Instructions: Confirm accuracy and completeness of Section 1 of the PPQ. Complete Section 2 of the PPQ and submit Sections 1 and 2 directly to the Contracting Officer (dominguej@state.gov). Do not forward a copy of the completed questionnaire to the Offeror whose performance you are evaluating. To be considered, the information must be received by the Government prior to the solicitation closing date and time.

INSERT DATE

SUBJECT: Past Performance Questionnaire for (PROGRAM TITLE/DESCRIPTION) concerning contract number(s) (CONTRACT AND ORDER NUMBER (IF APPLICABLE) TO BE EVALUATED). The effort was performed by (SPECIFIC ENTITY THAT PERFORMED THE WORK) under (UEI /CAGE code).

1. My company is responding to the US Department of State Request for Proposal (RFP) number 19AQMM25R0201 (INL Haiti SMEs and Logistical Support). The Government is placing increased emphasis on past performance to obtain best value in source selections. The RFP requires that we, as an Offeror, send the attached questionnaire to several points of contact (POCs) on recent and relevant efforts that we (or a proposed team member) have performed.

2. We have identified the subject contract(s) as relevant to this acquisition and you as our POC. As such, please take a few moments of your time to fill out the attached questionnaire and forward a signed and completed copy directly to the US Department of State. DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO US. The information contained in the completed Present/Past Performance Questionnaire is considered Source Selection Information (See FAR 2.101 and FAR 3.104) and may not be released to us.

3. The completed Past Performance Questionnaire (Sections 1 and 2) should be sent directly to the US Department of State not later than (DATE TO BE INSERTED BY OFFEROR, PRIOR TO PROPOSAL DUE DATE AND TIME). The questionnaire should be emailed to dominguej@state.gov.

4. If you have any questions regarding the questionnaire, you may contact Jocabed Domingue at dominguej@state.gov. Thank you for your timely assistance.

Sincerely, (TITLE AND NAME OF COMPANY OFFICIAL)

Attachment: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

SECTION 1 – TO BE COMPLETED BY OFFEROR

This Past Performance Questionnaire is submitted in response to RFP number 19AQMM25R0201 (INL Haiti SMEs and Logistical Support) as part of <insert name of prime offeror> proposal.

1. Company Information: Include name, address, and UEI / cage code of company (prime or major subcontractor) that performed this reference.

2. Program Title:

3. Contract Number (including Delivery / Task Order number if applicable):

4. Contract Award Basis: |_| Competitive |_| Non-Competitive

5. Contract Date:

6. Role Performed for this Reference:

|_| Prime Contractor |_| Subcontractor |_| Other: (Specify)

If other than a prime contractor, provide the prime contractor’s name, address, and UEI / cage code:

7. Name and Address of Contracting Activity / Customer:

8. Primary Points of Contact: Ensure that current information is provided for all individuals.

9. Contract Type(s): List all that apply (e.g. FFP, FPIF, CPFF, CPIF, LH, T&M).

10. Contract Value:

a. Awarded Total Contract Value:

(Including all options)

b. Current Total Contract Value:

(Including all options)

c. Explanation for difference between awarded and current contract values:

11. Period of Performance:

a. Current (including all exercised options): MM/DD/YEAR to MM/DD/YEAR

b. Potential (including all options): MM/DD/YEAR to MM/DD/YEAR

12. Place of Performance: List all that apply. If multiple locations, please indicate annual dollar value, total full-time equivalents (FTEs), and number of distinct labor categories per location.

13. Scope of work

a. Describe work performed by your company:

b. Relevancy: Provide information that demonstrates the relevancy of this reference to RFP requirements.

14. What were the key positive attributes about your performance?

15. What were the less than positive attributes and how were these resolved? The offeror is required to clearly demonstrate management actions employed in overcoming problems and the effects of those actions in terms of improvements achieved or problems rectified. Comment on any known performance deemed unacceptable to the customer, or not in accordance with the contract terms and conditions.

16. Has this contract been partially or completely terminated for default or convenience?

|_| Yes |_| No

If yes, please provide additional details:

17. Are there any pending terminations?

|_| Yes |_| No

If yes, please provide additional details:

SECTION 2 – TO BE COMPLETED BY ASSESSOR

Your feedback is requested by the US Department of State. Please e-mail the completed and signed questionnaire (both Section 1 and Section 2) to FernandezJM@state.gov.

DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO THE OFFEROR. The information contained in the completed Past Performance Questionnaire is considered Source Selection Information (See FAR 2.101 and FAR 3.104) and may not be released to the Offeror.

EVALUATED BY:

I, the undersigned, being familiar with the work and the performing organization I am providing information about, have responded to the best of my knowledge and belief. I understand that a representative of the Department of State may contact me for confirmation of my responses to this PPQ. I am authorized by my organization to complete this evaluation.

1. Is the information completed by the Offeror in Section 1 of this questionnaire accurate, current, and complete?

|_| Yes |_| No

If no, please explain / correct:

2. Performance Evaluation

Assign a rating to each area based on the ratings guidelines below. Please provide a narrative explanation for any rating of marginal or less.

a. Quality of Services:

1. Contractor provided personnel with the appropriate security clearances, qualifications, and experience required to perform the contract.

2. Performance conformed to contract requirements, specifications, and standards of good workmanship (e.g. commonly accepted technical, professional standards).

3. Contractor provided accurate and complete reports and other documentation.

4. Contractor was proactive in identifying, notifying the Government, and resolving performance issues/concerns.

b. Compliance with Schedule:

1. Contractor performed services in a timely manner.

2. Contractor provided contract reports and deliverables on time.

c. Cost Control:

1. Contractor completed performance within the established cost parameters.

2. Contractor invoices were timely, accurate, and complete.

3. Contractor actions resulted in cost savings to the Government without sacrificing quality of services or schedule.

d. Business Relations:

1. Contractor has a history of reasonable and cooperative behavior and effective business relations.

2. Contractor is dedicated to customer satisfaction.

3. Contractor has a history of submitting viable and timely proposals for required contract modifications or task orders.

4. Contractor effectively adapt to changes in mission requirements and priorities.

e. Management

1. Contractor effectively managed multiple task orders simultaneously covering multiple disciplines and locations.

2. Contractor effectively selected, retained, supported, and replaced (when necessary) personnel with the experience and expertise necessary to accomplish Government requirements.

3. Contractor adequately managed and controlled government furnished property and facilities.

4. Contractor effectively managed all subcontractors.

3. Did personnel vacancies occur during the contract / order PoP?

If yes, did the Contractor obtain replacements on time to prevent mission impact?

4. Identify the contractor’s overall strengths and weaknesses:

If no, please explain:

5. Would you have concerns working with this firm again?

|_| Yes |_| No

If yes, please explain:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104

WHEN COMPLETED, FOR OFFICIAL USE ONLY