Attachment J.2 Past Performance Questionnaire.docx
DOCX document 29 KB Posted
- Attached to
- Tuberculosis Laboratory Testing Services for U. S. Pacific Islands Federal contract opportunity
- Solicitation number
- 75D301-20-R-67962
About this file
This document includes a past performance questionnaire template and information on a related federal contract opportunity for tuberculosis laboratory testing services in the U.S. Pacific Islands. The opportunity is a solicitation issued by the Department of Health and Human Services Centers for Disease Control and Prevention Office of Acquisition Services. It has a base period of one year followed by four one-year option periods and seeks tuberculosis testing services for ten Pacific Island locations. Offerors must submit three completed past performance questionnaires from previous clients along with key details on the client, contract and evaluation of the offeror's performance. Responses are due to the contracting officer by the date specified. The past performance questionnaire templates require references to rate and comment on various aspects of the offeror's compliance, business practices, quality, terms and conditions and customer satisfaction on previous contracts.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment J.1 ACH Vendor Miscellaneous Payment Enrollment Form.pdf | ||
| TB Lab Testing Services Solicitation 75D301-20-R-67962 FINAL.pdf | ||
| Attachment J.4 Public Voucher for Purchases and Services Other Than Personal - Continuation Sheet.pdf | ||
| Attachment J.3 Public Voucher for Purchases and Services Other Than Personal.pdf |
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Text version
ATTACHMENT J2
Solicitation No.
75D301-20-R-67962
PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE INSTRUCTIONS
Instructions: The OFFEROR shall complete the PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE Reference Information Table themselves for the attached questionnaire, identifying the name and other pertinent information for each of the 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 to complete the questionnaire;
c) Instructs the customer to return the completed questionnaire to the Contract Specialist:
Ms. Denedra Threatt, by email: dthreatt2@cdc.gov
Submit a copy of the customer’s cover letter with your business proposal to ensure receipt of questionnaire responses.
PAST/PRESENT PERFORMANCE REFERENCE QUESTIONNAIRE
Solicitation No.
75D301-20-R-67962
Name of Offeror:
Reference Information Table
| Business Name of Reference |
| Address of Reference |
| Point of Contact |
| Phone number |
| E-mail address |
| Contract or Purchase Order Number |
| Dollar Value |
| Period of Performance |
| Description of Services Performed |
| Explain any problems and resolutions |
| P/U |
| S |
| G |
| VG |
| E |
| N |
| Poor/Unsatisfactory |
| Satisfactory |
| Good |
| Very Good |
| Excellent |
| Neutral |
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:
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.)?
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?
4. How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?
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?
6. How would you rate the contractor’s overall performance?
7. Would you purchase services from this contractor again?
|_| YES |_|NO
Please provide any additional comments applicable to the contractor’s past performance:
EVALUATOR’S NAME (Signature): ___________________________________________
TITLE OF EVALUATOR:___________________________________________
PHONE NUMBER:________________________________________________
EMAIL ADDRESS:_______________________________________________
DATE: _________________
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