Attachment 4 - Past Performance Questionairre.docx

SOLICITATION HT940825QE005

ATTACHMENT 2

Attachment 2 Past Performance Questionnaire

This attachment is in support of the Solicitation HT940825QE005.

NOTE: For each Project Summary Sheet submitted, the Offeror must submit either a completed Contractor Performance Assessment Reporting System (CPARS) evaluation or this Past Performance Questionnaire. If CPARS evaluation is available, it must be used and this Attachment 2 should not be submitted.

PAST PERFORMANCE PROJECT IDENTIFICATION (To be filled out by the Offeror):

PAST PERFORMANCE REFERENCE INFORMATION (To be filled out by the Rater):

Any questions concerning completion of this form should be addressed to Khaireyal.y.barcia.civ@health.mil and Meagan.e.askew.civ@health.mil.

INSTRUCTIONS

This questionnaire is to be completed as indicated below. For purposes of these evaluations, the term “client engagement” is intended to mean “contract”. This package consists of the following:

SECTION 1: AUTHORIZATION LETTER

(To be completed by the Offeror)

Past Performance Form Letter Example (This form letter is provided for Offerors to use in transmitting the Past Performance questionnaire to past or current clients)

[Date of Letter] [Name and Address of Offeror’s client] Attention: [Name and Designation of Client’s Contract Manager or Appropriate Contact]

Dear [Contact Name]:

We are currently responding to the Defense Health Agencies (DHA) Solicitation HT940825QE002. DHA is requesting organizations or companies responding to the solicitation to submit evidence of past performance. Through this letter we are requesting your participation to provide an assessment of our firm’s performance. If you are contacted for information on work our firm has performed outside of this written assessment, you are hereby authorized to respond to those inquiries. Your firm’s cooperation with this effort is greatly appreciated. Please direct any questions to [Insert Name and Phone Number for Offeror].

For your reference, we have included a description of the work our firm performed/is performing for your organization. A Past Performance Questionnaire is also enclosed for you to complete. Please verify the accuracy of the data in Sections 2 and 3 of the enclosed evaluation. Then, please complete Sections 4 and 5 and return the signed, completed document by DATE /TIME to [insert].

Sincerely, [Name of Signer] [Designation of Signer]

Past Performance Questionnaire

Solicitation HT940825QE002

When completed, this document contains procurement sensitive information.

SECTION 2: CLIENT ENGAGEMENT PROFILE

(To be completed by the Offeror and verified by the Client Point of Contact (POC)) Client Organization Name

U.S. Federal Government Department and Agency (if applicable)

Contractor Name:

Subcontractors and Partners (if any):

Contract Type:

(e.g., Time and Materials, Fixed Price, Unit-based, Asset-based, etc. or Combination/Hybrid) Please explain fully.

No

Total period of performance, including options: (MM/YYYY - MM/YYYY or MM/YYYY – Present)

Summary Description of Services Provided:

Geographic Coverage of Services for This Contract:

(e.g., Local, National, Global)

Project size:

(e.g., number and type of geographic locations supported concurrently)

Project complexity (e.g., number FTE’s)

SECTION 3: CLIENT IDENTIFICATION

(To be completed by the Client POC) POC Name:

Client POC Title/Position:

Client POC Email Address:

Client POC Phone Number:

Number of years the Client POC was associated with this engagement:

Is Section 2 of this questionnaire accurate?

If No, please explain:

Yes/No

SECTION 4: EVALUATION

Evaluation — Please indicate your satisfaction with the service provider’s performance by placing a “X” in the appropriate block using the rating scales to the right of each dimension. Additionally, if desired, please provide a narrative explanation to support your ratings. At a minimum, for any Marginal or Unsatisfactory rating, please submit additional comments to substantiate the rating. For any rating that is checked Not Applicable, please explain why it does not apply.

1. QUALITY OF SERVICE

Customer should place an “X” on the appropriate qualitative rating. Comments are optional.

__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory __ Not Applicable

Comment:

General Comments (General compliments, problems, and/or corrective actions taken to address the quality of services):

Click here to enter text.

2. SCHEDULE

Customer should place an “X” on the appropriate qualitative rating. Comments are optional.

__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory

General Comments (General compliments, problems, and/or corrective actions taken to address schedule):

ADDITIONAL COMMENTS (General compliments, problems, and/or corrective actions taken to address schedule):

Click here to enter text.

3. MANAGEMENT

Customer should place an “X” on the appropriate qualitative rating. Comments are optional.

__ Very Good __ Satisfactory __ Marginal __ Unsatisfactory

General Comments (General compliments, problems, and/or corrective actions taken to address the management services):

ADDITIONAL COMMENTS:

Click here to enter text.

SECTION 5: PAST PERFORMANCE SUMMARY

Provide an overall rating for the Contractor using the evaluation rating scale below.

On a scale of 1 to 5, how likely would you be to use the Contractor again?

If you have any further information that was not covered by this questionnaire, but you feel is important, please provide this information

Client POC’s Signature

Date

CUI

Source Selection Information – See FAR 2.101 and 3.104