B08_SOL_-_Attachment_4_-_Past_Performance_Questionnaire_1.docx

DOCX document 32 KB Posted

Attached to
Health & Human Services (HHS) Administration Community Living (ACL) Indefinite-
Solicitation number
140D0423R0055
Issued by

View the file

Other files

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

Attachment 4 – Past Performance Questionnaire Solicitation 140D0423R0055

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: ____________________________________________________________________

B. Contract number: _______________________________________

C. Contract type: ______________________________

D. Was this a competitive contract? Yes _____ No _____

E. Period of performance: _________________________________________________________

F. Initial contract cost: $____________________________

G. Current/final contract cost: $_______________________________

H. Reasons for differences between initial contract cost and final contract costs:

I. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name and title:

B. Evaluator's phone/fax number:

C. Number of years evaluator worked on subject contract: _____________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE
PERFORMANCE LEVEL
O
OUTSTANDING - The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example to others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as “Excellent”.
E
EXCELLENT – The contractor has substantially exceeded the contract performance requirements.
G
GOOD – There are no, or very minimal issues and the contractor has met the contract requirements.
F
FAIR – Overall compliance requires minor agency resources to ensure achievement of contract requirements.
P
POOR – Overall compliance requires significant agency resources to ensure achievement of contract requirements.
U
UNSATISFACTORY – Non-conformances are jeopardizing the achievement of contract requirements, despite use of agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.
N
NOT APPLICABLE - Unable to provide a score
Quality of Product or Service
O
E
G
F
P
U
N

Ability to understand/comply with customer objectives and technical requirements

Effectiveness of assigned personnel in terms of the appropriate mix of education and experience to accomplish the requirement.

Adequacy/effectiveness of quality control program

Quality/effectiveness of sub-contracted efforts

Program Management, Timeliness of Performance & Business Relations
O
E
G
F
P
U
N

Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

Timeliness/effectiveness of contract problem resolution without extensive customer guidance

Ability to successfully respond to emergency and/or surge situations

Effectiveness of material management (including Government Furnished Property or Material)

Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

Transition/Phase-in & Employee Retention/Attraction
O
E
G
F
P
U
N

Contractor ability to smoothly transition resources and personnel.

Contractor effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

Ability to hire/apply a qualified workforce to this effort.

Ability to retain a qualified workforce on this effort.

Cost Control
O
E
G
F
P
U
N

Accuracy in forecasting contract costs

Ability to meet forecasted costs and perform within contract costs

Ability to alert Government of unforeseen costs before they occur

Sufficiency and timeliness of cost reporting

Government Contracts Only: has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___Default___Convenience___Pending Terminations___
No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

What were the contractor’s greatest strengths in the performance of the contract?

What were the contractor’s greatest weaknesses in the performance of the contract?

Would you hire this contractor in the future to perform one of your critical and demanding programs?

Please provide any additional comments concerning this contractor’s performance, as desired.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Email Address: stephanie_mccullough@ibc.doi.gov, Attention: Stephanie McCullough

RFP: 140D0422R0016

File details come from the government source that posted it. Updated .