Attachment_5_Past_Performance_Questionnaire_Sentinel.doc
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- Attached to
- Sentinel Initiative Federal contract opportunity
- Solicitation number
- FDA-19-RFP-1209951
About this file
This document contains a past performance questionnaire for a contractor bidding on the Sentinel Initiative solicitation from the Food and Drug Administration. The past performance questionnaire requests ratings on a contractor's previous performance in meeting requirements, timeliness, quality of deliverables, and cost control. It must be completed by a reference for a contract listed by the contractor in its proposal and submitted to the FDA contract specialist by the stated due date. The related federal contract opportunity notice indicates the Sentinel Initiative solicitation is from the FDA to provide unspecified products or services and lists the solicitation number and agency contact information.
Attachment 5 Past Performance Questionnaire
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Attachment 5 – Past Performance Questionnaire
We are currently in the process of preparing our proposal for the United States Food and Drug Administration, (FDA) Solicitation Number ______________. 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, Tara Hobson on e-mail: Tara.Hobson@fda.hhs.gov; Phone: 240-402-7586 The Questionnaire is due to Tara Hobson no later than _________ Eastern Standard Time on ____________. 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.
| EXCEPTIONAL |
| Performance EXCEEDS MOST contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns. |
| VERY GOOD |
| Performance EXCEEDS SOME contractual requirements. The performance of areas being assessed was accomplished with few minor issues or concerns, for which the Contractor’s corrective actions were highly effective. |
| SATISFACTORY |
| Performance MEETS contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the Contractor were effective. |
| MARGINAL |
| Performance MEETS SOME contractual requirements. The performance of the areas being assessed includes significant problems, issues, or concerns for which corrective actions taken by the Contractor were only somewhat effective. |
| UNSATISFACTORY |
| Performance DOES NOT MEET contractual requirement. The performance of the areas being assessed includes serious problems, issues, or concerns for which the Contractor’s corrective actions were ineffective. |
| NOT APPLICABLE (N/A) |
| Performance information not recent or relevant as defined in the Solicitation. Unable to provide assessment. |
Past Performance Evaluation
Question 1. Performance What is your assessment of the Contractor’s ability to meet your requirements?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Performance
Comments, if any.
Questions 2 and 3. Timeliness
What is your assessment of the Contractor’s ability to provide products in a timely manner?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Timeliness
Ability to Resolve Timeliness Problems
Question 4. Quality of Deliverables What is your assessment of the quality of the Contractor’s deliverables?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
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?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Cost Control
Question 6. Overall Rating of Contractor’s performance What is your overall rating of Contractor’s performance (requirements, schedule, and price) on contract being assessed?
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
General Comments:
PAGE
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