Past_Present Questionnaire Final.docx

FOR OFFICIAL USE ONLY

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

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

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor and Cage Code of contractor contract was awarded to:__________________________________

B Contract #: ________________Period of Performance w/ Opt Yrs: Start Date:_________ End Date:________ C Total Contract Amount (include mods and options): $____________________________________________ D. Description of service provided: ____________________________________________________________ E Evaluator's Name, Title, and phone/fax #______________________________________________________ F Organization Name:______________________________________________________________________ Please circle which efforts were performed under this contract:

1. Research Project Manager Services 2. Research Medical Laboratory Technologist Services

3. Research Assistant Services 4. Research Director Assistant Services 5 .Research Laboratory Assistant Services

6. Research Biostatistician Services 7. Animal Surgical Research Technician Services

8. Protocol Administrative Technician Services 9. Clinical Research Coordinator Services Contractor performed how many man-hours of clinical research services per year __________.

Circle the applicable facility under this contract: government healthcare, civilian healthcare or university facility.

SECTION 2: EVALUATION

Please complete this questionnaire based on the following guidance:

A. Handwritten responses are sufficient. Please write legibly.

B. Please discuss each and every response for which you indicated 5/E (5/Exceptional), 2/M (2/Marginal) or 1/U (1/Unsatisfactory) in response to the questions below. Space for your narrative remarks is provided in Section 3 REMARKS (use additional sheets, if necessary).

C. Indicate, based on the performance levels defined below, the contractor’s performance on the identified program. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

PERFORMANCE LEVELS

You are urged to supplement your own knowledge of the contractor’s performance with the judgment of others in your organization.

Please return the completed questionnaire to: 802 CONS/LGCC-C, 1655 Selfridge Avenue, Lackland AFB, TX 78236, Attn: Florence Taplin, Phone Number (210) 671-9916 or DSN 473-9916 or email florence.taplin.1@us.af.mil

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:

C1. Research Project Manager.

C2. Research Medical Laboratory Technologist.

C3. Research Assistant.

C4. Research Director Assistant.

C5. Research Laboratory Assistant.

C6. Research Biostatistitian

C7. Animal Surgical Research Technician

C8. Protocol Administrative Technician

C9. Clinical Research Coordinator

E1. Ability to hire/apply a qualified workforce to this effort.

E2. Ability to support the program with limited staff turnover.

E3. Ability to retain incumbent staffing upon award of contract, E4. Contractor ability to staff short term (6 months or less) personnel.

S1. Contractor provided personnel with the knowledge required to maintain and fully support Clinical Research Division operations with technical, professional, and administrative personnel.

S2. Contractor provided personnel with relevant experience to fill research positions within the Division.

S3. Contractor personnel performed all tasks assigned according to written guidance and met all requirements associated with their position.

Has/was this contract been partially or completely terminated for default or issued a cure or show cause notice?

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

SECTION 3: REMARKS

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

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

Evaluator’s Signature Date

SAMPLE TRANSMITTAL LETTER

ABC COMPANY

(NOTE: This information should be on company letterhead.)

SUBJECT: Present/Past Performance Questionnaire for (PROGRAM TITLE/DESCRIPTION) concerning contract number(s) (CONTRACT & ORDER NUMBER [IF APPLICABLE] TO BE EVALUATED). The effort was performed by (SPECIFIC ENTITY THAT PERFORMED THE WORK) under (CAGE Code)

1. We are currently responding to 802D CONTRACTING SQUADRON (802 CONS/LGCC-C), Request for Proposal (RFP) FA3047-11-R-0020 for Clinical ResearchServices. This acquisition is being conducted as a past-performance/price evaluation. The RFP specifically requires that we, as an Offeror, send the attached questionnaire to several points of contract (POC) on recent and relevant efforts that we (or a proposed team member) have performed.

2. We have identified subject contract(s) as relevant to this acquisition and you as our POC.

As such, please take a few moments of your time to fill out the attached questionnaire and forward it directly to 802 CONS/LGCC-C. DO NOT RETURN THE COMPLETED QUESTIONNAIRE TO US. The information contained in the completed Present/Past Performance Questionnaire is considered sensitive and cannot be released to us, the Offeror.

3. The completed Present/Past Performance Questionnaire should be sent directly to the Government not later than (DATE TO BE INSERTED BY OFFEROR, PRIOR TO DUE DATE). The questionnaires should be mailed to: 802 CONS/LGCC-C; ATTN: Florence Taplin, 1655 Selfridge Avenue, Lackland AFB, TX 78236-5253. If you need to speak to Ms. Taplin please call (210) 671-9916 or DSN 473-9916.

4. If you have any questions regarding source selection, contact the Contracting Officer, Candy Trumpfheller at e-mail: candy.trumpfheller@us.af.mil by phone at (210) 671-5906. If you have questions regarding the clarification of contract number, POC, or program title, please contact (CONTRACTOR’S POC AND PHONE NUMBER FOR PAST PERFORMANCE ISSUES). Thank you for your timely assistance.

SAMPLE SUBCONTRACTOR CONSENT LETTER

Past performance information concerning subcontractors and teaming partners cannot be disclosed to a private party without the subcontractor’s or teaming partner’s consent. Because a prime contractor is a private party, the Government will need that consent before disclosing subcontractor/teaming partner present and past performance information to the prime during discussions or negotiations. In an effort to assist the Government’s Performance Risk Assessment Group (PRAG) in assessing your past performance risk, we request that the following consent form be submitted for each of the teaming partners or major subcontractors that you identify in your proposal. This information should be submitted as part of your Present and Past Performance Volume (or offer).

SAMPLE:

(NOTE: This information should be on company letterhead.)

Subcontractor/Teaming Partner Consent Form for the Release of Present and Past Performance Information to the Prime Contractor Dear (Contracting Officer), We are currently participating as a (SUBCONTRACTOR/TEAMING ARRANGEMENT/MENTOR PROTÉGÉ’/JointVENTURE) WITH (PRIME CONTRACTOR OR NAME OF ENTITY PROVIDING OFFER) in responding to the Department of the Air Force, 802d CONS/LGCC-C, Request for Proposal (RFP) No. FA3047-11-R-0020 for the acquisition of Clinical Research Services.

We understand that the Government is placing increased emphasis on past performance in order to obtain best value in source selections. In order to facilitate the performance risk assessment process we are signing this consent form in order to allow you to discuss our present and past performance information with the prime contractor during the source selection process.

(Signature of individual who has the authority to sign for and legally bind the company)

(Title of above individual) Company Name: __________________________________________ Address: _________________________________________________ CAGE Code: ______________________________________________ Phone Number and Fax Number: ______________________________

SAMPLE CLIENT AUTHORIZATION LETTER

In an effort to assist the Government’s Performance Risk Assessment Group (PRAG) in assessing your past performance on recent and relevant commercial contracts, we recommend that the following letter be sent to your points of contact for those commercial efforts that you identify in your Past Performance Volume:

SAMPLE (for commercial contracts):

(NOTE: This should be placed on company letterhead Client Authorization Letter Dear (COMMERCIAL CLIENT/CUSTOMER), We are currently responding to the Department of the Air Force, 802d CONS/LGCC-C Request for Proposal (RFP) No. FA3047-11-R-0020for the acquisition of Clinical Research Services. The Government is placing increased emphasis on past performance in order to obtain best value in source selections. They are requesting that clients of companies who submit offers in response to their RFP for the program/effort identified above be identified and that their participation in the validation process be requested. Therefore, in the event you are contacted for information on work we have performed on (LIST PROGRAM); you are hereby authorized to respond to those inquiries.

We have identified Mr. / Ms. (NAME) of your organization as the point of contact based on their knowledge concerning our work. Your cooperation is appreciated. Any questions may be directed to (NAME, TITLE, PHONE NUMBER AND FAX NUMBER FOR THE POC).

Sincerely, (OFFEROR’S POINT OF CONTACT)