Attachment_3_Past_Performance_Questionnaire.doc

Attachment 3

FDA-RFQ-1114590

past PERFORMANCE QUESTIONNAIRE

TO:

FACSIMILE:

PHONE:

EMAIL:______________________

INFORMATION REQUEST

PAST PERFORMANCE

The U.S. Food & Drug Administration is currently in the process of soliciting offers for a contract. [CONTRACTOR NAME] has provided your name and organization as a reference regarding [CONTRACTOR’S NAME] record of past performance under Contract No. [CONTRACT NO.]. Specifically, we are looking for past performance information in the following areas:

a.) Quality of Product or Service b.) Timeliness or Scheduling of Service/Deliveries c.) Business Relations d.) Key Personnel and Staffing (Including Subcontractors) e.) Cost Control (COST CONTRACTS ONLY)

In order for our team to compile its evaluation, we request that you complete the attached survey form and email it, and any other pertinent information, by xxxxxxx to xxxxxxx at xxxxxxx.

Any relevant information you have would be vital in our assessment of the aforementioned Contractor. Thank you for your assistance.

For your convenience, a cover sheet for use in mailing/faxing is provided below.

U.S. Food & Drug Administration Office of Acquisitions and Grants Services Attn: XXXXXX

(Point of Contact Name)

(Facsimile/Phone Number)

(E-mail Address)

XXXXX

(E-mail Address)

XXXXX

PAST PERFORMANCE QUESTIONNAIRE

CONTRACTOR NAME:

CONTRACT NUMBER:

EVALUATION PERIOD:

TASK ORDER NO.:

1.

Please describe the service/supply provided by the Contractor for your firm.

2. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional (E),Very Good (VG), Satisfactory (S), Marginal (M), or Unsatisfactory (U). For ratings of “Exceptional,” “Marginal,” or “Unsatisfactory,” please provide a brief explanation.

OVERALL PAST PERFORMANCE RATING

Please provide an overall rating of the contractor’s past performance for the referenced contract/delivery order a.) Quality of Product or Service:

Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence.

b.) Timeliness or Scheduling of Service/Deliveries:

Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction

Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business subcontracting program and satisfaction with Contractor’s service.

d.) Key Personnel and Staffing (Including Subcontractors)

Quality of key personnel and how well key personnel managed their portion of the contract.

e.) Cost Control (COST CONTRACTS ONLY)

Actual cost/rates reflect closely to negotiated cost/rates, adequate budgetary internal controls, current, accurate and complete billings.

3.

Would you hire this contractor to provide services for your organization in the future? Please provide comments using additional pages if desired.

Printed Name/Title

Phone Number/Email

Signature

Date