Attachment C_Past Performance Questionnaire.docx

FDA Nationwide Ergonomic Services Request for Quotation (RFQ) No. 75F40126Q00019 Attachment C: Past Performance Questionnaire (PPQ)

PAST PERFORMANCE QUESTIONNAIRE

Please complete the following questionnaire and return via email: Please reference “Past Performance Questionnaire, FDA Nationwide Ergonomic Services, RFQ No. 75F40126Q00019” in the subject line. Send to Melinda Kim, Contract Specialist, at Melinda.Kim@fda.hhs.gov and CC: Contracting Officer, Nicholas Bisher, Nicholas.Bisher@fda.hhs.gov.

Contracting Officer, Nicholas Bisher (Title, Name)

The U.S. Food and Drug Administration (FDA) intends to compete a single-award Purchase Order among responsible small business concerns to obtain Contractor support to assist the FDA’s Office of Occupational Safety and Health (OOSH) in facilitating a safe and healthy work environment for FDA employees through ergonomic consultative services. The FDA seeks Contractor support to provide a wide range of nationwide ergonomic services including, but not limited to: ergonomic assistance in office workstations; ergonomic equipment handling; and laboratory, vivarium, and support space ergonomic consultations.

The Contractor shall provide the FDA with the following services: (1) ergonomic education presentations, trainings, and participation at FDA or OOSH sponsored health fairs or similar events held periodically; (2) ergonomic consultation regarding the selection of furniture and equipment as needed; and (3) staffing for the ergonomics assessments needed at FDA facilities such as White Oak, College Park, and Rockville in Maryland, and at other FDA regional offices located throughout the United States.

This survey pertains to Contractor: ________________________________________

Department/Component:

Contract Number: Date of Survey: ________________

Name of Person Completing Survey: ______________________________________

Your Company/Agency: ________________________________________________

Contract Value (including options): $_________________________________

Performance Period: _____________________________________________ (Including option periods)

Type of Contract:

Approximate percentage of work being performed (or completed) by subcontractor(s): %

Information on subcontractor(s) (where more than 51% of work was completed by the subcontractor):

________________ Subcontractor Program Manager Phone

________________ Subcontractor Program Manager Phone

________________ Subcontractor Program Manager Phone

General description of products/services required under the contract:

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support rating shall be noted on page 4.

Assign each area a rating of, 1 (Poor), 2 (Fair), 3 (Good),or 4 (Excellent). Use the attached Rating Guidelines as guidance in making these evaluations. Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle "N/A" (not applicable/no opinion).

BUSINESS RELATIONS

1. Contractor provides knowledgeable, experienced, trained and qualified personnel.

1 2 3 4 N/A

QUALITY OF SERVICE

2. Contractor is responsive to technical direction.

1 2 3 4 N/A

COST CONTROL

TIMELINESS OF PERFORMANCE

8. Liquidated damages assessed: Yes No (circle one)

CUSTOMER SATISFACTION

1. The contractor is committed to customer satisfaction. Yes No (circle one)

2. Would you recommend this contractor for award (Yes or No)? Please explain.

Yes No (circle one)

3. Are you satisfied with the service you received and would you hire the contractor again (Yes or No)? If not, why not? Please be specific.

4. Do you feel the quality of the services received was worth the cost/price? Please circle one of the statements below.

A). Extremely well worth the cost.

B). Well worth the cost.

C). Worth the cost.

D). Cost was more than the value received.

E). Cost was greatly in excess of value received.

F). Government derived no value from cost spent.

ADDITIONAL COMMENTS:

RATING GUIDELINES

QUALITY OF PRODUCT OR SERVICE

COST CONTROL

TIMELINESS OF PERFORMANCE

BUSINESS RELATIONS

1-Poor

Major problems have been encountered

Contractor is having major difficulty managing costs effectively

Contractor is having major difficulty meeting milestones and delivery schedule

Response to inquiries, technical/ service/ administrative issues is marginally effective

2-Fair

Some problems have been encountered

Contractor is having some problems managing costs effectively

Contractor is having some problems meeting milestones and delivery schedule

Response to inquiries, technical/ service/ administrative issues is somewhat effective

3-Good

Minor inefficiencies/ errors have been identified

Contractor is usually effective in managing costs

Contractor is usually effective in meeting milestones and delivery schedule

Response to inquiries, technical/ service/ administrative issues is usually effective

4-Excellent

Contractor is in compliance with contract requirements and/or delivers quality products/services

Contractor is effective in managing costs and submits current, accurate, and complete billings

Contractor is effective in meeting milestones and delivery schedule

Response to inquiries, technical/ service/ administrative issues is effective