Attachment_D_Past_Performance_Questionnaire_(2).docx

Attachment D

FDA PAST PERFORMANCE INFORMATION QUESTIONNAIRE

Please complete the following questionnaire and return via e-mail to the following:

Mr. Sean Wybenga, Contract Specialist by 4:00 p.m. ET on July 1, 2016 (Name) (Date) U.S. Food and Drug Administration

Sean.wybenga@fda.hhs.gov (Email)

This survey pertains to:_______________________________________________________________________________

Agency/Company/Entity:

Contract Number: Date of Survey:

Name of Person Completing Survey:

Signature of Person Completing Survey:

Your Company/Agency/Entity:

Your Role in this Contract (circle one):

Contracting Officer Contract Specialist Project Officer Other

Contract Value (including options): $

Performance Period:

(including option periods)

Type of Contract:

Attachment D

FDA PAST PERFORMANCE INFORMATION QUESTIONNAIRE

RATINGS

Please respond to each of the following prompts with a rating that is based on objective measurable performance indicators to the maximum extent possible. Commentary to support rating may be provided on page 3.

Assign each area a rating of 0 (Unsatisfactory), 1 (Poor), 2 (Fair), 3 (Good), 4 (Excellent), or 5 (Outstanding). Circle the appropriate rating. If you do not have enough personal knowledge or feedback from internal customers who directly received products and services from the contractor to make a determination on any of the performance criteria below, please circle "N/A" (not applicable/no opinion).

Effectiveness of the vendor’s management 0 1 2 3 4 5 N/A

1. Overall, would you characterize the vendor as committed to customer satisfaction.

Yes No (circle one)

2. Would you recommend selection of this firm again?

Yes No (circle one)

ADDITIONAL COMMENTS