Attachment_5_-_Past_Performance_Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Submission Instructions: The company that has provided you with this questionnaire is responding to a Consumer Financial Protection Bureau (CFPB) Request for Proposal (CFP-13-R-00003) for Redress and Civil Penalty Fund 3rd Party Administration Services. Please note: All information contained in this form must be typed. Thank you for your participation.

Questionnaire About [insert name of requesting company/contractor]

Company/Contractor Providing Services

Company/Contractor’s role (work performed as a Prime or Subcontractor?) __________________

Contract Number/Identifier

Original Contract Estimated Value ____ ____ Estimated Value at Completion ___

Percentage of Work Completed ___________

Contract Performance Period

Contract Type (Fixed Price, Fixed Unit Price, Time & Materials, Cost, etc.) ____________

Questionnaire Completed By [insert name of reviewing company/agency]

Thank you, in advance, for providing us with valuable information needed to conduct a past performance evaluation. Upon completion of this questionnaire, please send a signed, scanned version as an email attachment directly to the CFPB at Matthew.Chmielewski@cfpb.gov, no later than 10:00 a.m. Eastern Time on April 22, 2013. Those submitted after that time will not be considered. In the email subject line, please state “PPQ Submission.” If you have any questions about this questionnaire, please contact Matthew Chmielewski at the CFPB: Matthew.Chmielewski@cfpb.gov.

Name

Title

Company/Agency

Address

Telephone Email Address ______

Signature Date Questionnaire (To be completed by reviewing company/agency) For (name of requesting company)

Questionnaire Instructions: Please answer questions 1 through 8, below, by providing a brief statement of your observations during the time you received support/services from the requesting company. If applicable, please describe any problems or performance failures that prompted your comments. Additional pages may be attached if needed. Contractor is defined as the requesting company which provides services to the reviewing company/agency.

1. Describe the type of services the contractor provided and the contractor’s technical expertise.

Comments:

2. Address whether the contractor provided the following types of services and, if yes, briefly explain the nature of those services:

a.Establishment and management of client case-specific funds, accounts and reporting: Y / N Explain: ___________________________________________________________________ b.Responses to general public inquiries, and addressing consumer-specific complaints: Y / N Explain: __________________________________________________________________

c. Distribution of funds to eligible claimants and/or maintenance of client case-specific database tracking, contact information, and payment data: Y / N Explain: ____________________________________________________________________

d. Maintenance of claims verification process: Y / N Explain: ____________________________________________________________________

3.Describe the quality of service you received from the contractor, including its ability to adequately staff its team with competent personnel. Please note if the contractor used subcontractors and whether there were proper controls in place to ensure the subcontractor performed in accordance with the contract requirements.

Comments:

4. Describe the contractor’s ability to adjust to contract, program and/or schedule changes, and to meet established deadlines. Additionally, please identify whether there were any instances where missed deadlines affected the timing of other deliverables and overall contract performance.

Comments:

5. Describe the contractor’s identification and mitigation of project-related risks.

Comments:

6. Describe the contractor’s willingness to work as a team with your personnel and with contractor staff from other companies (if applicable).

Comments:

7. Describe any instances of breaches in security or unauthorized transfers, releases, or sharing of information and the contractor’s response.

Comments:

8. Overall, would you hire this contractor for similar services again?

Comments:

9. Please provide any additional relevant information to assist us in conducting our evaluation of the contractor’s past performance.

Comments: