Attachment G.4 - Past Present Performance Questionnaire.docx

ATTACHMENT G.4

RFP 75D301-21-R-71962

PAST/PRESENT PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

Instructions: OFFEROR shall complete the PAST/PRESENT PERFORMANCE QUESTIONNAIRE Reference Information Table themselves for the attached questionnaire, identifying the name and other pertinent information for each of your three (3) selected business references. This table, including the name of the offeror, shall be filled out completely by the offeror BEFORE sending it to the customers to respond to the questions. This will ensure the accuracy of the information being provided.

Send the attached questionnaire to each of the customers with a cover letter that:

a) Authorizes the selected customers to discuss the offeror’s performance under the applicable contract with the contracting officer;

b) Requests the customer complete the questionnaire;

c) Instructs the customer to return the completed questionnaire to the Contracting Officer:

Mr. Eric Lyons, by email: kpy2@cdc.gov

Submit a copy of the customer’s cover letter with your business proposal to ensure receipt of questionnaire responses.

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

RFP 75D301-21-R-71962

Name of Offeror:

Click or tap here to enter text.

Reference Information Table

Does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas; deficiencies in one or more areas which adversely affect overall performance.

Meets or slightly exceeds minimum acceptable standards; adequate results; reportable deficiencies with identifiable, but not substantial, effects on overall performance.

Effective performance; fully responsive to contract requirements; reportable deficiencies, but with little identifiable effect on overall performance.

Very effective performance; fully responsive to contract requirements; contract requirements accomplished in a timely, efficient, and economical manner for the most part; only minor deficiencies with minimal effect on overall performance.

Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall performance.

No record of relevant past performance or past performance information is not available

1. How would you rate the contractor’s compliance with the delivery schedule / performance milestones?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

2. How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

3. How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

5. How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

6. How would you rate the contractor’s overall performance?

Comments: Click or tap here to enter text.

P/U ☐ S ☐ G ☐ VG ☐ E ☐ N ☐

7. Would you purchase services from this contractor again?

Comments: Click or tap here to enter text.

☐ YES ☐ NO

Please provide any additional comments applicable to the contractor’s past performance: Click or tap here to enter text.

EVALUATOR’S NAME (Signature): ___________________________________________

TITLE OF EVALUATOR:___________________________________________

PHONE NUMBER:________________________________________________

EMAIL ADDRESS:_______________________________________________

DATE: _________________