Attachment No. 5 - Past Performance Questionnaire (Revised).doc

Attachment 5 – Past Performance Questionnaire

FDA-23-SOL-116650 A

Contract for Sampling and Analysis

We are currently in the process of preparing our proposal for the United States Food and Drug Administration, (FDA) Solicitation Number FDA-23-SOL-116650. As part of our proposal, we have listed you as a reference on our performance for this type of service with your agency under the previous/current contract listed below. Your input on our performance is therefore requested.

Please complete this Questionnaire Contract Specialist, Hilda M. Aryeh e-mail: Hilda. Aryeh @fda.hhs.gov.

The Questionnaire is due to Hilda M. Aryeh no later than 3:00 PM Eastern Standard Time on September 13, 2023. Questionnaire must be submitted directly to the Contract Specialist on company letterhead if faxed or emailed from a corporate email account.

Thank you.

NAME OF OFFEROR:

Phone:

E-Mail:

I. Current or Historical Contract Information

CONTRACT REFERENCED:

1. Contract or Identifying Number: ________________________________________________

2. Contract Value: _____________________________________________________________

3. Period of Performance: ______________________________________________________________________________

4. Brief description of services provided:

5. Name of Person Completing Questionnaire: _______________________________________ Agency/Company:

Title: __________________________________ Phone: _____________________________

E-mail: _____________________________________________________________________ Signature:____________________________________________________________ II. EVALUATION. Please rate the Contractor utilizing the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Evaluation Definitions – The following definitions should be used in the assessment of Contractor performance.

Past Performance Evaluation

Question 1. Performance What is your assessment of the Contractor’s ability to meet your requirements?

Performance

Comments, if any.

Questions 2 and 3. Timeliness

What is your assessment of the Contractor’s ability to provide deliverables in a timely manner?

Timeliness

Ability to Resolve Timeliness Problems

Question 4. Quality of Deliverables What is your assessment of the quality of the Contractor’s deliverables?

Quality of Deliverables

Question 5. Cost Control (Cost/T&M Contracts Only) Did the contractor succeed at keeping actual cost/projected level of effort consistent with the negotiated/awarded cost ceiling/projected level of effort? Did the contractor provide adequate budgetary internal controls, current, accurate, and complete billings?

Cost Control

Question 6. Small Business Goals (If applicable) In accordance with FAR 15.304(c)(3)(ii), if the performance of this contract required a subcontracting plan, describe the contractor’s success/ability in obtaining the goals set out in their plan?

General Comments:

Question 7. Overall Rating of Contractor’s performance What is your overall rating of Contractor’s performance (requirements, schedule, and price) on contract being assessed?

General Comments: