Attachment 5 - Past Performance Evaluation Questionnaire.docx
DOCX document 40 KB Posted
- Attached to
- FDA NCTR On-Site Pathology Services Federal contract opportunity
- Solicitation number
- 75F40125R00059
About this file
The provided document is a Past Performance Evaluation Questionnaire for Solicitation Number 75F40125R00059, issued by the Department of Health and Human Services Food and Drug Administration Office of Acquisition and Grant Services. The questionnaire is a detailed form designed to capture comprehensive performance feedback from previous clients, focusing on evaluating a contractor's performance across seven key areas: quality of product or service, schedule, cost control, management/business relations, small business subcontracting, regulatory compliance, and other areas.
The evaluation form provides a structured mechanism for rating performance using a five-tier scale from Unsatisfactory to Exceptional, with each rating requiring specific narrative justification. The questionnaire seeks to assess the contractor's overall performance, customer satisfaction, and potential for future work by gathering detailed input from reference clients. The form is specifically associated with an FDA NCTR On-Site Pathology Services contract opportunity, requiring contractors to provide comprehensive documentation of their past performance and capability to meet the agency's requirements.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 75F4012500059_QA_5-16-25.pdf | ||
| 75F4012500059_QA_5-12-25.pdf | ||
| Attachment 1 Pathology PWS.pdf | ||
| PWS Appendix 3.pdf | ||
| PWS Appendix 6.pdf | ||
| Attachment 2 - Pricing Schedule.xls | XLS spreadsheet | |
| Attachment 6 - Sample Client Letter for Past Performance.docx | DOCX document | |
| Attachment 7 SCLS Incumbent Employee Length of Service Information.pdf | ||
| 75F40125R00059.pdf | ||
| PWS Appendix 1.pdf | ||
| PWS Appendix 2.pdf | ||
| PWS Appendix 4.pdf | ||
| Attachment 3 - Wage Determination No. 2015-5121 (Rev. 25).pdf | ||
| PWS Appendix 5.pdf | ||
| Attachment 4 FDA Form 3398.pdf |
Show all 15
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Text version
ATTACHMENT 5 – PAST PERFORMANCE EVALUATION QUESTIONNAIRE
Solicitation Number 75F40125R00059
1. Contract Identification: (to be completed by offeror)
Offeror Name and Address, Offeror Point of Contact Name/Title, Telephone Number, and E-Mail Address:
Reference (client) Information: Agency/Company Name and Address, Agency Point of Contact Name/Title, Telephone Number and E-Mail Address, for/ to whom this questionnaire was submitted:
Contract information for which this questionnaire was submitted:
Contract Number: _____________________________________________________________________ Contract Type: _______________________________________________________________________ Period of Performance: _________________________________________________________________ Total Contract amount: _________________________________________________________________ Location of Work: _____________________________________________________________________
Description of Work, scope, and responsibilities:
Relevance of the referenced contract to the current requirement: ____________________________________________________________________________________
Problems encountered in performance and corrective actions taken:
Company’s capacity served on the project, i.e., prime, subcontractor etc.
2. Agency/Company Identification: (to be completed by Client)
Description of Work Performed and the Contractor’s Association with the Project (Prime, Subcontractor, etc.) ________________________________________________________________________________
3. Contractor Performance Ratings:
https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Evaluation+Areas Please rate the Contractor’s performance by utilizing the rating and definition provided below. For the FDA to fully assess performance, it is imperative that ratings be accompanied by supporting narrative (comments):
| Rating |
| Definition |
| Justification |
| 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. |
| To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
| 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. |
| To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified. |
| 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. |
| To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order |
| 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 |
| To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter). |
| 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 |
| To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters). |
Please evaluate the following areas:
1. Quality of Product or Service (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Quality)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
Rating Narrative: ______________________________________________________________________
2. Schedule (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Schedule)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
3. Cost Control (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Cost+Control)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
4. Management Business Relations/Key Personnel https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Management
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
5. Small Business Subcontracting (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Small+Business)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
6. Regulatory Compliance (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Regulatory)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
7. Other Areas (https://cpars.cpars.gov/cpars/common/helpinfo_input.action?module=cpars&scope=de&topic=Other+Areas)
| ☐ | Exceptional |
| ☐ | Very Good |
| ☐ | Satisfactory |
| ☐ | Marginal |
| ☐ | Unsatisfactory |
| ☐ | N/A |
8. Is/was the contractor committed to customer satisfaction?
| ☐ | Yes |
| ☐ | No |
Narrative:
9. Would you hire this contractor to provide products/services for your organization in the future?
| ☐ | Yes |
| ☐ | No |
Please explain why or why not:
Evaluator Information:
Name (please print):
Title:
Work phone number (including area code): __________________________________________________________________
E-Mail address:
Signature:
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