Attachment_8_-_Past_Performance_Questionnaire.docx

ATTACHMENT 8: IHS HIT Modernization – Past Performance Questionnaire All information submitted shall be UNCLASSIFIED

SECTION A (TO BE COMPLETED BY OFFEROR)

CONTRACT INFORMATION:

A. Contractor: _________________________

B. Role in IHS HIT Modernization (Prime/Sub): _________________

C. Contractor Address: ___________________________

D. Contract/Task Order Number: __________________ Status: Active _____ Completed _____

E. Performed as Prime Contractor or Subcontractor: ________________

F. Project Title: _______________________________________________

G. Contract Type: ______________________________________________

H. Final (or current, if still active) Total Contract Value: $________________

I. Period of Performance: _______________________

J. Project Description (Include discussion on size, scope, and complexity as well as how this project is relevant to the IHS HIT Modernization requirement):

SECTION A (CONTINUED)

K. Contracting Officer Name, Agency/Organization, and Contact Information (if applicable):

L. Customer or End User, Agency Contracting Officer’s Representative, Task Monitor, or Program Manager Name and Contact Information (Phone Number and Email):

M. Name of Reference, Organization, and Contact Information (Phone Number and Email):

SECTION B (TO BE COMPLETED BY REFERENCE)

***Add Additional Lines to Each Response as Needed*** Note: If you cannot provide complete, honest, and objective feedback, please do not complete this form. Additionally, in the interest of full disclosure, please note if your contract with the Offeror listed above includes a non-disparagement clause.

1. Does your contract with the Offeror listed above include a non-disparagement clause?

Yes _____ No _____

2. Is the contract accurately described above? If not, please provide additional clarification.

3. Describe the quality and completeness of the deliverables provided by the contractor under this contract.

4. Has the contractor delivered all contract requirements in a timely manner? Did the contractor ever provide support ahead of schedule? If the contractor was ever late on a deliverable, was there a valid reason for the delay?

5. Describe the contractor’s effectiveness in forecasting, managing, and controlling contract costs. (Please do not complete this question if the contract type was Firm Fixed Price.)

6. Describe the contractor’s effectiveness in managing contract execution. Was the contractor’s management responsive to the customer’s requests?

SECTION B CONTINUED

7. Describe the contractor’s overall performance in accomplishing the specific tasks comparable to IHS HIT Modernization. Please provide as much detail as possible.

8. Would you be willing to have this contractor do this type of work for your organization in the future?

9. Is there anything else worth noting regarding the contractor’s performance on this project not already addressed in one of the questions above?

SUBMIT COMPLETED PAST PERFORMANCE QUESTIONNAIRE NO LATER THAN 9 AM (ET) ON TBD TO:

Margaret Fitting, Contracting Officer Email: Margaret_Fitting@ibc.doi.gov

Mike Horvath, Contract Specialist Email: Michael_Horvath@ibc.doi.gov

Important Note: Completed questionnaire shall be submitted to the Contracting Officer and Contract Specialist by the reference and NOT by the contractor being evaluated. Completed questionnaires received from the contractor will not be accepted.