ATTACHMENT_ DRAFT 70B06C23R00000121 Wellness App PAST PERFORMANCE QUESTIONNAIRE_.docx

ATTACHMENT 3 – Past Performance Questionnaire PART ONE: INSTRUCTIONS The company who has provided you with this form is proposing on a Department of Homeland Security, Customs and Border Protection solicitation. Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important. Your response on this form shall be sent directly to Shaun G. Saad, the DHS CBP Contracting Officer. Do not send back to the requesting company or individual. Please provide an honest assessment and return the questionnaire by e‐mail to SHAUNGALEN.SAAD@CBP.DHS.GOV by Close of Business, 5PM EST August 25th, 2023.

PART TWO: GENERAL INFORMATION

1. OFFEROR’S NAME AND ADDRESS 2. CUSTOMER ORGANIZATION

70B06C23R00000121

3. CONTRACT NUMBER:

2a. EVALUATOR

4. CONTRACT VALUE: $

NAME: TITLE:

PHONE NO:

5. CONTRACT AWARD DATE: 6. CONTRACT COMPLETION DATE:

7. CONTRACT TYPE: 8. COMPLEXITY OF WORK (Circle One)

DIFFICULT ROUTINE

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

The workforce care (WFC) mobile application will provide easy access on both CBP work phones and personal phones to access mental health content, as well as an enterprise resiliency dashboard for management’s awareness (e.g., trends, services used, etc.). The WFC mobile application will be available to CBP employees, their families, and in the future possibly CBP retirees. The mobile application technical requirements include the capability to provide 24/7/365 on-demand meditation, mental health and wellness content NS SMS-text-based tools providing regular check in with users. Links to mental health resources and CBP resources will also be available from the application in appropriate logical places via CBP.GOV web addresses (e.g., URLs) provided by the government to specific resources. The mobile application will also provide push check-in notifications (or similar functionality) to users based on past use of mobile content or decrease in application utilization and provide multiple application configuration options based on user preferences.

PART THREE: OFFEROR PERFORMANCE RATING

On the following pages, please summarize the offeror’s performance in each rating factors. Each factor has a set of subfactors with four possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this offeror and indicate your assessment by placing an “X” under the appropriate heading. Offeror performance factors are:

A. CUSTOMER SATISFACTION

B. ADHERENCE TO PRICE, SCHEDULE, AND PERFORMANCE BASELINES

C. TIMLINESS OF PERFORMANCE

Adjectival ratings are defined below and should be used as a reference in assessing performance:

SUPERIOR = Offer’s performance met all contract requirements and exceeded many to the customer’s benefit. Offeror’s performance has resulted in a high level of efficiency, productivity and quality. Very little risk anticipated with performance or lack of customer satisfaction.

SATISFACTORY = Offer’s performance met customer expectations or contract requirements. Some potential risk and lack of customer satisfaction is anticipated based upon the offeror’s past performance.

MARGINAL = Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which the contractor’s corrective actions were only marginally effective.

UNSATISFACTORY

(UNSAT) = Performance did not meet most (or all) contractual requirements.

There were serious problems and the contractor’s corrective actions were ineffective.

provide customer support to end users (e.g., applicants).

provide customer support to administrative level users.

(a) Performance of services

(b) Delivery of reports or other documentation

(c) Resolution of app deficiencies

PART THREE: OFFEROR PERFORMANCE RATING CONTINUED

1. Has this contract been partially or completely terminated for default or convenience?

YES Default

NO

Convenience

If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules - also include contract number, name, address, and phone number of Terminating Contracting Officer - TCO).

2. What was the contractor’s greatest strength in the performance of the contract?

3. What was the contractor’s greatest weakness in the performance of the contract?

4. Would you award another contract to this contractor?

YES No

COMMENTS:

PART FOUR: EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

SIGNATURE OF EVALUATOR

TITLE OF EVALUATOR