Attachment 4 - PPQ_VISN 12 Infusion Pump Systems.pdf

FOR OFFICIAL USE ONLY

PAST PERFORMANCE QUESTIONNAIRE

1. Contractor Name:

Role on Project:

3. Contractor Address:

5. Procuring Agency/Company Name:

7. Period of Performance:

9. Title of Contract:

2. Contract Number:

4. Contract Type:

D Firm Fixed Price

0 T&M/LH

D Cost Reimbursement

D Other (Please Specify):

6. Agency/Company POC:

Phone:

Email:

8. Dollar Amount of Award: $

Annual Amount: $

Total Dollar Value w/ Mods:$

10. Description of Contract Service/Scope of Contract:

INSTRUCTIONS: Please email completed questionnaire directly to Tammy Mattox at tammy.mattox@gsa.gov

FOR OFFICIAL USE ONLY

Your cooperation in completing this questionnaire is greatly appreciated. Please note that your responses will not be shared with the firm you are evaluating. Your response is requested no later than Thursday, September 8th, 2022 at 4:00 PM CST through

NOTE: Please use adjectival ratings from attached sheet.

12. Evaluation Factor 13. Comments (Mandatory, Attach additional sheets, if necessary.)

a. Quality of Product

b. Training Services

c. Parts & Service

Availability

d. Customer Satisfaction

e. Timeliness of Delivery/ Performance

f. End User Technical

Support/Troubleshooting

Assistance

g. Overall Performance

14. Rating

15. Would you select this contractor again? Please explain. (Attach additional sheet if necessary.)

D Definitely □ Probably □Definitely Not

16. Name: 17. Title:

Date:

FOR OFFICIAL USE ONLY 2

PAST PERFORMANCE RATING GUIDELINES

Summarize Contractor Performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, and Exceptional. Use the following instructions as guidance in making these evaluations. Please use the comments area on the preceding form to justify the rating given.

Ratings Parts & Service Customer Technical Support/ Quality of Product/ Training Services Availability Satisfaction Troubleshooting

Timeliness of Delivery/Services

Customer Satisfaction is a -Met interim measure of how milestones products and -Reliable services supplied -Responsive to by a company technical direction

-Compliance w/contract requirements -Accuracy of reports -Ease of product use -Technical excellence -Quality of End-user Onsite training -Quality of Bio-Med Onsite Training -Quality of Pharmacy Onsite training meet or surpass -Completed on time customer expectations.

-Spare Parts Availability -Provided list of consumables and starter supplies -Anticipated long-term parts support -Minimum one year warranty (parts & labor)

-Effective Support -Easy Access to Troubleshooting -Responsive to support reqmnts -Prompt notification of problems -Reasonable/ cooperative -Flexible -Pro-active

Unsatisfactory Non conformances 1 -Very Delays are are comprising the Unsatisfied compromising

Technical Support/ Troubleshooting is not effective achievement of contract achievement of reqmnts contract reqmts Marginal Nonconformances 2-Somewhat Delays require require major agency Dissatisfied major agency Technical Support/ Troubleshooting is marginally effective resources to ensure resources to ensure achievement of contract achievement of reqmnts

Parts/Service issues are comprising performance

Parts/Service Issues require major agency resources to ensure achievement of contract reqmnts contract reqmnts

Satisfactory Non conformances 3-Neither Delays do not do not impact Satisfied Nor impact achievement

Technical Support/ Troubleshooting is usually effective achievement of contract Dissatisfied of contract reqmnts reqmnts

Parts/Service issues do not impact achievement of contract reqmnts

Very Good There are no quality 4-Somewhat problems/issues, and the Satisfied contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government

Exceptional The contractor has 5 -Very Satisfied demonstrated an exceptional performance level that was significantly in excess of anticipated achievements and is commendable as an example for others. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance

There are no delays

The contractor has demonstrated an exceptional performance level.

It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

Response to inquiries and/or technical support/ troubleshooting issues are effective.

The contractor has demonstrated an exceptional performance level.

It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Exceptional".

levels described as "Exceptional".

There are no parts/ service issues and the Contractor has exceeded the contract requirements

The contractor has demonstrated exceptional parts/ service support.

It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Exceptional".

FOR OFFICIAL USE ONLY 3