Attachment C Past Performance 03.27.26.pdf

Attachment C

PAST PERFORMANCE QUESTIONNAIRE LETTER

Date:

Dear Client:

We are currently responding to the Health Resources and Services Administration (HRSA) Solicitation No. RF 75R60126Q00001 entitled, NHDP Laundry Services. The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

Email: @hrsa.gov

RF #75R60126Q00001

Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above email address no later than the closing date of the Request for April 8 at 12:00 PM EST

We thank you for your prompt response in this matter.

Sincerely, (To be signed by offeror)

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

For: __________________________________________________________________ Name of Company

Please Return Completed Survey To:

Email: @hrsa.gov

Please Fill In The Following:

Your Name: __________________________________________ Your Agency: _________________________________________ Address: _____________________________________________ Phone Number: ________________________________________ Fax Number: __________________________________________

Signature of Person Completing Survey: _________________________________

Contract Number / Solicitation Number: ________________________________

Your Role In This Contract (circle one)

Project Officer

Contracting Officer

Contract Specialist

Approximate Percentage of Work Competed by Subcontractors: _______ %

General Description or work or Title of Contract:

Standard Contractor Performance Report

Contract Type: Contract Number / Order Number:

Contractor Name:

Contract Award Date:

Contract Expiration Date:

Contract Value:

Supplies or Services:

Ratings

Summarize contractor performance and check the selection which corresponds to the rating for each rating category (See attached Rating Guidelines). Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Quality of Product or Service:

Unsatisfactory Poor Fair Good Excellent Outstanding

Government Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Firm Fixed Price):

Unsatisfactory Poor Fair Good Excellent Outstanding

Government Comments for Quality of Product or Service (2000 characters maximum):

Timeliness of Performance:

Unsatisfactory Poor Fair Good Excellent Outstanding

Government Comments for Quality of Product or Service (2000 characters maximum):

Business Relations:

Unsatisfactory Poor Fair Good Excellent Outstanding

Government Comments for Quality of Product or Service (2000 characters maximum):

Additional Info

Subcontracts:

Are subcontracts involved? ____Yes ____No (Check one)

Comment on subcontracts (2000 characters maximum):

Customer Satisfaction:

Is / was the contractor committed to customer satisfaction? ____ Yes ____ No (Check one)

Would you recommend the selection of this firm again? ____ Yes ____ No (Check one)

Comments on Customer Satisfaction (2000 characters maximum):

Admin Info Project Officer / COR Name:

Phone:

Fax:

E-mail Address:

Contracting Officer:

Name:

Phone:

Fax:

E-mail Address:

Rating Guidelines

Quality of Product or Service

Unsatisfactory Non-conformances are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

Poor Overall compliance requires significant Agency resources to ensure achievement of contract requirements.

Fair Overall compliance requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, quality problems, and the contractor has met the contract requirements.

Excellent There are no quality issues, and the contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Cost Control

Unsatisfactory Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.

Poor Ability to manage cost issues requires significant Agency resources to ensure achievement of contract requirements.

Fair Ability to control cost issues requires minor Agency resources to ensure achievement of contract requirements.

Good There are no, or very minimal, cost management issues and the contractor has met the contract requirements.

Excellent There are no cost management issues and the contractor has exceeded the contract requirements, achieving cost savings to the Government.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. 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 "Excellent".

Timeliness of Performance

Unsatisfactory Delays are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.

Poor Delays require significant Agency resources to ensure achievement of contract requirements.

Fair Delays require minor Agency resources to ensure achievement of contract requirements.

Good There are no, or minimal, delays that impact achievement of contract requirements.

Excellent There are no delays and the contractor has exceeded the agreed upon time schedule.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Business Relations

Unsatisfactory Response to inquiries and/or technical, service, administrative issues is not effective. If not substantially mitigated or corrected it should constitute a significant impediment in considerations for future awards.

Poor Response to inquiries and/or technical, service, administrative issues is marginally effective.

Fair Response to inquiries and/or technical, service, administrative issues is somewhat effective.

Good Response to inquiries and/or technical, service, administrative issues is consistently effective.

Excellent Response to inquiries and/or technical, service, administrative issues exceeds Government expectation.

Outstanding The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".