Attachment J-5 Past Performance Questionnaire.pdf

Attachment J-5 Past Performance Questionnaire

Dear Sir or Madam:

The U.S. Food and Drug Administration (FDA), has a requirement to procure support services for laboratory design and safety engineering reviews; to maintain and manage primary barrier equipment; to provide industrial hygiene services;

and to support laboratory quality, security, and safety practices.

FDA is conducting a performance confidence assessment in anticipation of a possible contract award. An offeror interested in proposing on this work has identified you as a Point of Contact (POC) on a past or present contract which the Offeror deems relevant to this effort. FDA is requesting your assistance in completing the attached Past Performance Assessment Questionnaire so that we may evaluate the offeror under the Factor of past performance. The Questionnaire has been developed for ease of electronic completion. Please, provide your comments regarding the overall assessment of the Offeror’s performance on the contract identified and any additional information that your organization deems relevant to the FDA evaluation team. It is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators.

Please complete and submit the Questionnaire via e-mail to Contract Specialist at Linda.Troutman@fda.hhs.gov.

and Contracting Officer Monifa.coleman@fda.hhs.gov if you have any questions relative to the enclosed Questionnaire, please contact me.

Thank you in advance for your assistance

Past Performance Information Form

Adjectival Rating Definitions:

Substantial Confidence. Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires. Based on the Offeror’s recent/ relevant performance record, the Government has a high expectation that the Offeror will successfully perform the required effort.

Satisfactory Confidence. Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires. Based on the Offeror’s recent/relevant performance record, the Government has a reasonable expectation that the Offeror will successfully perform the required effort.

Neutral Confidence. Absent any recent and relevant past performance history or when the performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned, the Offeror will be assigned a “neutral confidence rating” and its proposal will not be evaluated either favorably nor unfavorably on past performance.

Limited Confidence. Present/past performance effort involved some of the scope and magnitude of mailto:Emmanuel.mbah@fda.hhs.gov mailto:Monifa.coleman@fda.hhs.gov effort and complexities this solicitation requires. Based on the Offeror’s recent/relevant performance record, the Government has a low expectation that the Offeror will successfully perform the required effort.

No Confidence. Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires. Based on the Offeror’s recent/relevant performance record, the Government has no expectation that the Offeror will be able to successfully perform the required effort.

Note***For any response of: Substantial Confidence or Limited confidence, or No Confidence, provide an explanation in the respective comments section.

PART I. (To be completed by the Offeror)

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

Substantial Confidence Satisfactory Confidence Neutral Confidence Limited Confidence No Confidence

Comments:

Substantial Confidence Satisfactory Confidence Neutral Confidence

A. Compliance of Products, Services, Documents, And Related Deliverables To Specification Requirements And Standards Of Good Workmanship

A. Contract Identification

B. Identification of Offeror’s Representative

B. Effectiveness of Project Management (to include use and control of subcontractors).

Limited Confidence (Explanation must be provided in Comments field below) No Confidence (Explanation must be provided in Comments field below)

Comments:

Substantial Confidence Satisfactory Confidence Neutral Confidence Limited Confidence No Confidence

Comments:

Substantial Confidence Satisfactory Confidence Neutral Confidence Limited Confidence No Confidence

Comments:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

Signature:

PART III. RETURN INFORMATION

Office of Operations, Office of Finance Budget & Acquisitions Office of Acquisitions and Grants Services, HFA-500 Division of Acquisition Programs (DAP) Facilities Support Branch (FSB)

Atten: Linda.Troutman@fda.hhs.gov Atten: Monifa.Coleman@fda.hhs.gov

E. General Comments. Provide any other relevant performance information.

C. Timeliness of Performance for Services and Product Deliverables.

D. Commitment To Customer Satisfaction And Business-Like Concern For Its Customers’ Interest

F. Other Information Sources. Please provide the following information:

H. Respondent Identification. Please provide the following information: