Attachment 4 - Past Performance Questionnaire - CLS-.xlsx
XLSX spreadsheet 22 KB Posted
- Attached to
- Comprehensive Life Support (CLS)
- Solicitation number
- 19AQMM23R0073
About this file
This document contains a past performance questionnaire and details of a solicitation for a comprehensive life support services contract. The Bureau of Medical Services within the Department of State is seeking proposals for comprehensive life support training for newly hired Foreign Service Medical Specialists. The incumbent contractor has provided the Comprehensive Advanced Life Support program for several years, including intensive provider courses and instructor certification training, to enhance trauma skills for medical professionals. This follow-on contract will continue life support training to maintain specialty skill levels. Offerors are to be evaluated on technical services, quality of services, price and cost controls, and customer satisfaction. The past performance questionnaire is to be completed by references and submitted by February 17, 2023. Questions regarding the solicitation are due by January 20, 2023 in advance of the proposal submission deadline.
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Other files
| File | Type | Posted |
|---|---|---|
| CLS RFQ Final - A0002 Final.pdf | ||
| Copy of Responses to CLS - Vendor Questions - A0002 Final.xlsx | XLSX spreadsheet | |
| 19AQMM23R0073 A0002.pdf | ||
| CLS RFQ Final - A0001.pdf | ||
| 19AQMM23R0073 A0001.pdf | ||
| 19AQMM23R0073.pdf | ||
| Attachment 2 - Pricing Table CLS V2.xlsx | XLSX spreadsheet | |
| CLS RFQ Final.pdf | ||
| Attachment 3 - Template for Vendor Questions.xlsx | XLSX spreadsheet |
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Text version
Past Performance Questionnaire
| 19AQMM23R0073 |
| PAST PERFORMANCE CUSTOMER SATISFACTION SURVEY |
| Introduction: The United States Department of State (DOS) is currently conducting a competitive procurement for Comprehensive Life Support services to support the Bureau of Medical Services (MED). The scope of this effort is described in the SOW. |
Offerors have been requested to identify Government agencies or commercial vendors with whom it is currently or has been recently under contract, to serve as potential references on its past performance record. You are being asked to complete this Past Performance Questionnaire (PPQ).
This PPQ is being submitted to reflect work performed by [Insert Name of Offeror Submitting Response to DOS Requirement]
| Instructions: Please complete all areas of this form indicated in light yellow. | ||
| PART I - CONTRACT INFORMATION | ||
| a. Contractor: | ||
| b. Customer Name (Federal Agency or Other): | ||
| c. Technical Point of Contact Information | ||
| i. Name: | ||
| ii. Telephone Number: | ||
| iii. Facsimile Number: | ||
| vi. Position Title: | ||
| d. Contract Number: | ||
| e. Type of Contract | (Select responses from drop down menu) | |
| i. Competitive or Non-Competitive: | ||
| ii. Firm-Fixed-Price, Cost-Plus, Time-and-Materials/Labor Hour, Hybrid, or Other: | ||
| f. Contract Period of Performance: | ||
| h. Initial Contract Value: $ | ||
| i. Current (or Completed) Contract Value: $ | ||
| j. Brief Description of the Contract Requirement: | ||
| PART II - GOVERNMENT PAST PERFORMANCE/CUSTOMER SATISFACTION EVALUATION | ||
| EVALUATION CRITERIA | ||
| EXCEPTIONAL: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated 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 contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. | ||
| SATISFACTORY: Performance meets contractual requirements. The contractual performance of the element or sub-element 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 contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. | ||
| UNSATISFACTORY: 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 or were ineffective. | ||
| EVALUATION AREA 1: TECHNICAL SERVICES | ||
| (Select the rating that applies from drop down menu) | ||
| Overall ability to provide comprehensive life support training: | ||
| Overall ability to manage a training program: | ||
| EVALUATION AREA 2: QUALITY OF SERVICES | ||
| (Select the rating that applies from drop down menu) | ||
| Overall quality of training services provided: | ||
| Quality of the training content and the trainers' subject matter knowledge and skills: | ||
| EVALUATION AREA 3: PRICE/COST CONTROL | ||
| (Select the rating that applies from drop down menu) | ||
| Quality, completeness, and accuracy of price/cost proposals/invoices: | ||
| Ability to perform within negotiated costs/prices: | ||
| Ability to provide innovative solutions that resulted in cost savings: | ||
| EVALUATION AREA 4: CUSTOMER SATISFACTION | ||
| (Select the rating that applies from drop down menu) | ||
| Maintains a single effective point of contact to manage and resolve problems: | ||
| Effectiveness in interfacing with personnel in your organization: | ||
| Overall ability to resolve performance issues: | ||
| COMMENTS (Please include any additional comments concerning the past performance of the contractor): |
| Thank you for completing this past performance evaluation. Please email the completed survey to the following address: |
| U. S. Department of State |
| Office of the Procurement Executive |
| ATTN: Robin Guillie and Qiana Richmond |
| E-MAIL ADDRESS: GuillieRL@state.gov and RichmondQJ@state.gov |
&1#&"Times New Roman"&10&K000000SENSITIVE BUT UNCLASSIFIED
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