B08_Attachment 0003 - Past Performance Questionnaire.pdf

W9133L22R1002 Source Selection Past Performance Questionnaire

Attachment 0003 Past Performance Questionnaire

For W9133L22R1002 Centralized Credentialing and Privileging (C&P) Services

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does.

Please return the completed Questionnaire to the Contract Specialist, Mr. David Gruenbaum, david.g.gruenbaum.civ@army.mil and the Contracting Officer, Ms. Trisha Ankney at patricia.e.ankney.civ@army.mil.

Adjectival Rating Definitions:

Substantial Confidence: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successfully in performing the required effort.

Satisfactory Confidence: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

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:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

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

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

Substantial Confidence (Explanation must be provided in Rationale field below) Satisfactory Confidence Limited Confidence (Explanation must be provided in Rationale field below) No Confidence: (Explanation must be provided in Rationale field below)

Rationale:

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

Limited Confidence (Explanation must be provided in Rationale field below)

C. Timeliness of Performance for Services and Product Deliverables.

Limited Confidence (Explanation must be provided in Rationale field below)

D. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

Limited Confidence (Explanation must be provided in Rationale field below)

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

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

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:

G. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contracting Officer/Specialist identified in the cover letter.

Thank you for your assistance.