ATTACHMENT 4B PAST PERFORMANCE QUESTIONNAIRE RCTA SURVEILLANCE.pdf

ATTACHMENT #4b Page 1 of 4

PAST PERFORMANCE QUESTIONNAIRE

Solicitation #: W9127Q-21-R-0013, Surveillance for Drug Enforcement Technical Instructional Services RCTA-MS

Your assistance is requested in support of a Source Selection. IMPORTANT: Offeror MUST NOT review the completed Past Performance Questionnaire (PPQ) before submission. All completed PPQs must be submitted by the reference directly to the USPFO-MS Contracting Office via email, fax, or mail (email preferred):

Mississippi Army National Guard Office of the U.S. Property & Fiscal Officer for MS Flowood, MS, 39232 ATTN: Ms. LaShanda Areghan Contract Specialist Email: Lashanda.d.areghan.civ@mail.mil

When completed, the information on this form becomes SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected, accordingly.

TO BE COMPLETED BY OFFEROR SUBMITTING PROPOSAL

1. Offeror Name & Complete Address: Offeror must complete blocks 2 -7 to identify the contract between the offeror and the evaluating organization. NOTE:

contract must be relevant (similar scope, complexity, target audience) to the RFP.

2. Contract No:

3. Contract Initiation Date:

4. Contract Completion Date:

5. Contract Value (including options): $

6. Type of Contract (i.e., Firm-Fixed Price (FFP), Cost, Time & Material):

7. Description of Service(s)/Course(s) provided under referenced contract. (Include enough detail to determine relevance to requested training. Please add a continuation sheet if more space is required):

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION:

a) Evaluator’s Name, Position:

b) Evaluator’s Phone #:

c) Evaluator’s Email:

d) Duration of Business Relations with Offeror’s Firm:

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Please select the response code which best reflects your experience with this contractor.

EX = Exceptional – Performance meets contractual requirements and exceeds many. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG = Very Good - Performance meets contractual requirements and exceeds some. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S = 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.

MG = 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.

US = Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The element being assessed contains serious problem(s) for which the contractor’ corrective actions appear or were ineffective.

N/O = Not Observed – Performance in this element or sub-element was not observed.

(Please provide narrative comments below each factor to identify specific strengths/weakness relative to that factor.)

A. Quality of Product/Service Course Design & Development EX VG S MG US N/O

Course Curriculum / Agenda EX VG S MG US N/O

Quality of Instruction EX VG S MG US N/O

Course Materials / Handouts EX VG S MG US N/O

Course Benefit in Workplace EX VG S MG US N/O

B. Schedule

Adherence to Schedule EX VG S MG US N/O

Flexibility in Scheduling EX VG S MG US N/O

C. Business Relations

Business/Contracting Relations EX VG S MG US N/O

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Problem Resolution EX VG S MG US N/O

Process Improvement EX VG S MG US N/O

Lesson Learned Incorporation EX VG S MG US N/O

Cooperative Behavior EX VG S MG US N/O

Commitment to Customer Satisfaction EX VG S MG US N/O

Responsiveness EX VG S MG US N/O

D. Management of Key Personnel (Instructors) Technical Knowledge in Course Subject Matter EX VG S MG US N/O

Thoroughness EX VG S MG US N/O

Accuracy EX VG S MG US N/O

E. Overall Assessment of

Contractor EX VG S MG US N/O

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9. For any elements identified above that were rated Marginal or Unsatisfactory, has unsatisfactory performance been shared with the contractor?

( ) Yes ( ) No If Yes, communications with the contractor were ( ) written / ( ) verbal.

10. PLEASE PROVIDE NARRATIVE COMMENTS TO IDENTIFY (please add continuation page for additional comments):

a) Two or three of the offeror’s best corporate traits or observed skills.

b) Areas where the offeror has the most room for improvement.